Lymph Node Dissection

IHAVELKA

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:confused:Does anyone know the correct code for a level VII lymph node dissection? I know 38746 is not the correct code as only one level was removed. Thanks!
 

lisigirl

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I agree that 38746 is too much but I'm not sure what other code you could use for these nodes. If no one else has a suggestion, what about 38746-52?

good luck. I'm interested to see what other people say.

Lisi, CPC
 

Jan CPC I

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I used to hate getting these opnotes because some codes in this section are too specific, while others are not specific enough. I beleive 38746 is an add on code and cannot be reported separately.

If this was a peratracheal node then I might code 38510, if it is a thorasic node, then it gets a bit tricky. Without reading the opnote I might suggest 2 options...

1. 38500 with a 22 added if the dissection was complex and not superficial.
2. 38999 with the same price

Not sure if this will help, options are not always clear for this type of procedure.
 

cmblocher

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I have an operative note with a similar scenario: It states "Mediastinal Lymphadenectomy was then undertaken at level 9". This was done in conjuction with an open lobectomy. I had thought of adding modifer 22 to the primary surgery (32480), or do you think I should use 32500-22?
 

lisigirl

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I would do one of the following:

1. 32480
38746-52
or
2. 32480
38500-22

Personally, I would probably bill with the first scenario. One more thing, my physician has told me that the level 9 nodes often come out with a lower lobectomy. If it wasn't substantially more work, maybe you shouldn't bill for it?? just a thought.

Lisi, CPC
 
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