How To Use CPT Code 38564

CPT 38564 describes a limited lymphadenectomy procedure for staging purposes in the retroperitoneal area near the aorta or spleen. This article will cover the description, procedure, qualifying circumstances, appropriate usage, documentation requirements, billing guidelines, historical information and billing examples.

1. What is CPT Code 38564?

CPT 38564 is used to describe a limited lymphadenectomy procedure performed to stage cancer in the retroperitoneal area, specifically near the aorta or spleen. This code is used when the provider excises lymph nodes from the retroperitoneum to determine the extent of the disease and plan treatment.

2. Official Description

The official description of CPT code 38564 is: ‘Limited lymphadenectomy for staging (separate procedure); retroperitoneal (aortic and/or splenic).’

3. Procedure

1. When the patient is appropriately prepped and anesthetized, the provider makes an upper midline laparotomy incision to access the abdominal cavity.
2. The provider explores the abdomen for indications of cancer in the retroperitoneum.
3. Lymph nodes in the retroperitoneum, including those near the spleen and aorta, are excised by the provider.
4. The excised lymph node samples are sent to pathology for examination.
5. Using the pathology results, the provider identifies the number and location of nodes with metastatic cancer and stages the cancer accordingly.
6. In cases of extensive metastatic cancer, the provider may sample lymph nodes in adjacent areas to determine the extent of the disease.
7. The provider then approximates the tissues in layers and closes the abdominal wound.

4. Qualifying circumstances

CPT 38564 is performed on patients who require staging of cancer in the retroperitoneal area. The procedure involves the excision of lymph nodes near the aorta or spleen. It is important to note that this code is used specifically for staging purposes and should not be reported for lymphadenectomy procedures performed 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.

5. When to use CPT code 38564

CPT code 38564 should be used when a limited lymphadenectomy procedure is performed to stage cancer in the retroperitoneal area near the aorta or spleen. It should not be used for lymphadenectomy procedures performed for therapeutic purposes. It is important to review the documentation and ensure that the procedure meets the specific criteria outlined in the code description.

6. Documentation requirements

To support a claim for CPT 38564, the provider must document the following information:

• Indication for the procedure and the need for staging
• Details of the procedure, including the approach and specific lymph nodes excised
• Pathology results and the number and location of nodes with metastatic cancer
• Staging of the cancer based on the pathology findings
• Any additional lymph nodes sampled in adjacent areas, if applicable
• Details of the closure of the abdominal wound

7. Billing guidelines

When billing for CPT 38564, ensure that the procedure meets the criteria outlined in the code description. It is important to note that CPT 38564 should not be reported in addition to other excisions for lymphadenectomy procedures. Modifier 58 may be necessary if the staging procedure occurs during the global period of a previous tumor removal or debulking procedure.

8. Historical information

CPT 38564 was added to the Current Procedural Terminology system on January 1, 1990. It was later added to the Inpatient Only (IPO) list for Medicare in 2017.

9. Examples

1. A provider performs a limited lymphadenectomy procedure in the retroperitoneal area near the aorta to stage cancer in a patient.
2. During a separate operative session, a provider excises lymph nodes near the spleen to determine the extent of cancer in the retroperitoneum.
3. A patient undergoes a limited lymphadenectomy procedure to stage cancer in the retroperitoneal area near the aorta.
4. A provider samples lymph nodes near the spleen and aorta to determine the stage of cancer in the retroperitoneum.
5. During a staging procedure, a provider excises lymph nodes in the retroperitoneal area near the aorta and sends them for pathology examination.
6. A limited lymphadenectomy procedure is performed to stage cancer in the retroperitoneum near the spleen.
7. A provider performs a separate operative procedure to excise lymph nodes near the aorta for staging purposes.
8. A patient undergoes a limited lymphadenectomy procedure to determine the extent of cancer in the retroperitoneal area near the spleen.
9. During a staging procedure, a provider samples lymph nodes near the aorta and sends them for pathology examination.
10. A provider excises lymph nodes near the spleen and aorta to stage cancer in the retroperitoneum.