Wiki Robotic low anterior resection with takedown of splenic flexure. Pelvic and abdominal lymphadenectomy

[vinrossct@gmail.com]

Does anyone know if the Lymphadenectomy is separately billable during the colectomy? or it is bundled? The op report does not specify which nodes were removed. This is the only mention of it in the OP report, "Left and right ureters were identified, and these vessels were taken with a very high ligation completing an extensive pelvic lymphadenectomy with the robotic vessel sealer." I've read that the nodes do not need to be specifically delineated but it certainly is not a bi total pelvic lymphadenectomy 36571. Not sure if a 38570 "retroperitoneal lymph node sampling biopsy 3857 would apply. So far I have a 44202 +44213. If anyone knows the answer ... Thanks in advance

 

[nickelclaw]

depends on location if scope is in retro-peritoneal space then 38570
if documentation mentions iliac vein, hypo-gastric, or obturator then 38571

https://www.urologytimes.com/view/how-code-pelvic-lymphadenectomy

Which lymph nodes should be included to be considered a "total" pelvic lymphadenectomy/CPT 38571? When should I consider using the unlisted code or adding a –52 modifier?
External iliac, hypogastric, and obturator nodes are all considered a part of a pelvic lymphadenectomy; however, 38571 (Laparoscopy, surgical; with bilateral total pelvic lymphadenectomy) does not specifically delineate which nodes have to be removed. Therefore, 38571 should be used to report all therapeutic pelvic lymphadenectomies with one caveat and one exception

The caveat: If the procedure is interrupted for some technical reason and you are unable to complete the procedure, then charge with the –52 modifier. Otherwise, charge without the modifier.

The exception: If peri-aortic lymph nodes sampling is added to the total pelvic lymphadenectomy, then charge 38572 (Laparoscopy, surgical; with bilateral total pelvic lymphadenectomy and peri-aortic lymph node sampling). If the intent is anything other than a total therapeutic lymphadenectomy performed through the laparoscope, you’re probably stuck with the appropriate unlisted code.
In summary, there is no discrete delineation or line to be drawn between groups or number of nodes, only intent and accomplishment.