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Pelvic and Para-aortic lymph node dissection.

Natalie Posted Tue 23rd of June, 2020 14:09:12 PM
The gyn oncologist at our office often does surgeries that involve both a bilateral pelvic lymph node dissection (often a 38770) and a bilateral para-aortic lymph node dissection (often a 38564). He usually does them with a hysterectomy - either open or laparoscopic approach. Sometimes he does an omentectomy during the surgery, but sometimes he does not. It's often for the diagnosis of endometrial cancer (C54.1). Supercoder (and our billing experience) say we can not code 38770 and 38564 together, but it doesn't look like the codes actually cover what the other entails? How do I bill these surgeries? If there is no omentectomy and no gross disease around the abdomen can you call it a debulking? How is it different billing laparoscopically versus open? Thank you.
SuperCoder Answered Wed 24th of June, 2020 07:54:36 AM

Thank you for your Question!


As per NCCI edit 38564 bundled into 38770. Code 38564 is a column 2 code for 38770. You may not override the edit.


38564 Limited lymphadenectomy for staging (separate procedure); retroperitoneal (aortic and/or splenic) does represent a peri-aortic sampling, reporting this code in addition is not an option because the Correct Coding Initiative permanently bundles 38564 into 38770. You may try billing this with modifier 22 to get the extra reimbursement for work performed in 38564. The coding would then be 38770-22.


Debulking aims to remove as much of cancer as possible if it has spread to other adjacent areas in the pelvis or abdomen. Debulking would be considered an integral part of the main procedure (either hysterectomy or omentectomy). Mainly these procedures are performed via two approaches either Open or Laparoscopic. The correct code selection would be determined basis the approach used to perform the major part of the surgery.


Note: The correct coding would depend upon the actual procedures performed on the same day.


Hope that Helps!  

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