Wiki 38746?

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Jenlyn

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The OP report states a "Right pneumonectomy and mediastinal lymph node biopsy" was performed. In the body of the OP report it states "a few failrly large mediastinal lymph nodes were disected and sent for biopsy. These lymph nodes turned out to be negative on frozen section." I have a consultant stating this biopsy should be coded with 38746. How would you code the mediastinal lymph node biopsy?

LK
 
Per the Society of Thoracic Surgeons, at a minimum, lymph nodes from levels 4,7 and 9 should be removed to bill with this code and it cannot just be a sampling from each level. You can find this info on the STS website, its in their Coding Newsletter for Feb 2008.

Lisi, CPC
 
The lymph nodes are assigned to different regions/levels/stations. Below are the levels and the lymph nodes contained in that level (these are the ones I know for CT surgery. One of my surgeons broke it down for me) -

2 - high paratracheal
4 - paratracheal
5,6 - aortopulmonary window
7 - subcarinal
8 - periesophageal
9 - inferior pulmonary ligament

10, 11, 12 - within the lung

8 & 9 are often removed with the lobe if it is a lower lobe.

I've seen surgeons refer to lymph node removal by both the numbers or the name so it helps to know both.

Lisi
 
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