How To Use CPT Code 38562

CPT 38562 describes the limited lymphadenectomy procedure used for staging cancer in the pelvic and para-aortic areas. This article will cover the official description, procedure details, qualifying circumstances, appropriate usage, documentation requirements, billing guidelines, historical information and billing examples.

1. What is CPT Code 38562?

CPT 38562 is a code used to describe a limited lymphadenectomy procedure performed to stage cancer in the pelvic and para-aortic areas. This procedure involves the surgical removal of lymph nodes in these specific regions to determine the extent of the disease and plan appropriate treatment. It is important to note that CPT 38562 should not be used in conjunction with other excisions for lymphadenectomy to treat disease, as it is bundled into procedures that already include lymphadenectomy.

2. Official Description

The official description of CPT code 38562 is: ‘Limited lymphadenectomy for staging (separate procedure); pelvic and para-aortic.’ It is important to consider any notes associated with this code, such as the requirement to use different codes when combining the procedure with prostatectomy or the insertion of a radioactive substance into the prostate.

3. Procedure

1. When performing CPT 38562, the healthcare provider begins by preparing and anesthetizing the patient.
2. A laparotomy incision is made to gain access to the abdominal cavity.
3. The provider explores the abdomen and pelvis to identify any evidence of cancer.
4. Lymph nodes in the pelvic and para-aortic areas are excised and collected for further examination.
5. The collected samples are sent to pathology for analysis to determine the presence of metastatic cancer and to stage the disease.
6. In cases of extensive metastatic cancer, the provider may also sample lymph nodes in adjacent areas to assess the extent of the disease.
7. The provider then closes the laparotomy wound by approximating the tissues in layers.

4. Qualifying circumstances

CPT 38562 is typically performed when there is a need to stage cancer in the pelvic and para-aortic areas. The procedure is indicated when there is evidence of cancer in these regions and when the provider needs to determine the extent of the disease for treatment planning. It is important to note that this procedure should only be performed as a separate operative session and not in conjunction with other excisions for lymphadenectomy to treat disease.

5. When to use CPT code 38562

CPT code 38562 should be used when a limited lymphadenectomy procedure is performed to stage cancer in the pelvic and para-aortic areas. It is important to ensure that this procedure is not reported in addition to other excisions for lymphadenectomy to treat disease, as it is already bundled into procedures that include lymphadenectomy. Modifier 58 may be necessary if the staging procedure occurs during the global period of a previous tumor removal or debulking procedure.

6. Documentation requirements

To support a claim for CPT 38562, the healthcare provider must document the following information:

• Patient’s diagnosis and the need for staging lymphadenectomy
• Details of the procedure, including the specific lymph nodes excised and their locations
• Pathology results indicating the presence of metastatic cancer and the stage of the disease
• Any additional lymph nodes sampled in adjacent areas, if applicable
• Use of modifier 58, if performed during the global period of a previous procedure

7. Billing guidelines

When billing for CPT 38562, it is important to ensure that the procedure is performed as a separate operative session and not in conjunction with other excisions for lymphadenectomy to treat disease. Modifier 58 may be necessary if the staging procedure occurs during the global period of a previous tumor removal or debulking procedure. It is crucial to review the specific billing guidelines provided by payers to ensure accurate reporting and reimbursement.

8. Historical information

CPT 38562 was added to the Current Procedural Terminology system on January 1, 1990. There have been several historical changes to this code, including its addition and removal from the Inpatient Only (IPO) list for Medicare. It is important to stay updated on any changes or updates related to CPT 38562.

9. Examples

1. A surgeon performs a limited lymphadenectomy procedure on a patient with suspected pelvic cancer to determine the stage of the disease.
2. A gynecologist performs a separate operative session for a limited lymphadenectomy procedure to stage cancer in the para-aortic area.
3. A urologist performs a limited lymphadenectomy procedure during the global period of a previous tumor removal procedure to assess the extent of metastatic cancer.
4. A general surgeon performs a limited lymphadenectomy procedure on a patient with suspected pelvic cancer and samples lymph nodes in adjacent areas to evaluate the extent of the disease.
5. An oncologist performs a limited lymphadenectomy procedure on a patient with suspected metastatic cancer in the pelvic and para-aortic areas to determine the stage of the disease.
6. A surgical oncologist performs a limited lymphadenectomy procedure on a patient with suspected pelvic cancer and uses modifier 58 to indicate that this is a staged activity during the postoperative period.
7. A gynecologic oncologist performs a limited lymphadenectomy procedure on a patient with suspected cancer in the pelvic and para-aortic areas and documents the specific lymph nodes excised and their locations.
8. A general surgeon performs a limited lymphadenectomy procedure on a patient with suspected pelvic cancer and includes pathology results indicating the presence of metastatic cancer and the stage of the disease in the documentation.