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When to code 38747 with organ resections

Kelly Posted Wed 04th of December, 2019 10:45:45 AM
When is it appropriate to code cpt 38747 with organ resections? There is not much guidance on this CCI edit Medicare only states within the operative field but what would be considered outside of the operative field. Nodes takes that were not part of the organ resection? Example: 1. Distal (Subtotal) Gastrectomy with Roux-Y reconstruction 43633 and 5. Abdominal (D2) Lymphadenectomy The pericardial, celiac, splenic, common hepatic lymph nodes were excised with cautery and Ligasure and submitted separately Would it be appropriate to use 38747-59
SuperCoder Answered Thu 05th of December, 2019 06:41:12 AM

Hello Kelly,

 

Thank you for your question.

 

 

NCCI version 25.3 bundles Code 38747 as a column 2 code for 43633, but you may use a CCI-associated modifier to override the edit under appropriate circumstances.

 

 

Hence, you can append modifier 59 with CPT® code 38747 for procedure performed along with 43633 to unbundle these procedures, as long as it is medically necessary to provide each service, and your documentation supports two separate services.

 

Note: As per NCCI guidelines CPT code 38747 (abdominal lymphadenectomy, regional, including celiac, gastric, portal, peripancreatic, with or without para-aortic and venal caval nodes...) shall not be reported for the excision of lymph nodes that are in the operative field of another surgical procedure.  For example CPT code 38747 shall not be reported for the excision of lymph nodes in the operative field of a gastrectomy, pancreatectomy, hepatectomy, colectomy, enterectomy, or nephrectomy.

Find undermentioned link for more clarification Under : NCCI Policy Manual for Medicare Services  – Effective January 1, 2019 (ZIP); Chapter: 5, V-24

https://www.cms.gov/Medicare/Coding/NationalCorrectCodInitEd/NCCI-Manual-Archive

 

 

Hope that helps!

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