Lori Posted Thu 25th of January, 2018 12:33:20 PM
During a CABG procedure, my provider did the following: "A hilar lymph node was encountered around the pulmonary veins and SVC and dissected out with cautery and submitted for specimen." How would this be coded? I am thinking 38530 but I'm not sure. There is no code for the hilar/hylar node dissection. Thank you in advance.
SuperCoder Answered Mon 29th of January, 2018 02:01:21 AM
There is no appropriate CPT code for hilar lymph node excision. I would suggest using unlisted CPT code 38999 (Unlisted procedure, hemic or lymphatic system). When submitting an unlisted-procedure code, your documentation should also include an explanatory cover letter. An insurer will decide to pay an unlisted-procedure claim by comparing your procedure description to a similar, listed procedure with an established reimbursement value.
I also looked for other possible options like CPT code 38530 but this code looks restricted to Internal Mammary gland only.
Also looked at CPT 38746 which is for thoracic, mediastinal and regional lymphadenectomy but this is an add on code and it cannot be billed with CABG CPT codes as per coding guidelines. CABG codes are not its primary procedure codes and hence cannot be billed with them.