How To Use CPT Code 38746

CPT 38746 describes the procedure of thoracic lymphadenectomy by thoracotomy, specifically involving the removal of mediastinal and regional lymph nodes. This article will cover the description, official details, procedure, qualifying circumstances, appropriate usage, documentation requirements, billing guidelines, historical information and billing examples.

1. What is CPT Code 38746?

CPT 38746 can be used to describe the surgical procedure of thoracic lymphadenectomy by thoracotomy, specifically targeting the removal of mediastinal and regional lymph nodes. This code is utilized when the provider incises the chest and performs the lymph node dissection along with another primary procedure.

2. Official Description

The official description of CPT code 38746 is: ‘Thoracic lymphadenectomy by thoracotomy, mediastinal and regional lymphadenectomy (List separately in addition to code for primary procedure).’ The notes associated with this code specify the lymph nodes included in the mediastinal area on both the right and left sides.

3. Procedure

1. When performing thoracic lymphadenectomy by thoracotomy, the provider makes an incision in the chest.
2. Depending on the approach, the provider either splits and retracts the sternum or spreads the ribs.
3. After completing the primary procedure, such as tumor removal, the provider inspects the mediastinum and carefully examines the mediastinal lymph nodes for any signs of disease.
4. If necessary, the provider removes the affected lymph nodes, potentially including all lymph nodes in the area of extensive metastatic cancer.
5. The provider ensures hemostasis to stop any bleeding and, if the sternum was split, wires it back together.
6. The subcutaneous tissues are reapproximated, and the incision is closed in layers. In some cases, a separate stab incision may be made to place a chest tube for postoperative drainage.

4. Qualifying circumstances

CPT 38746 is performed on patients who require the removal of thoracic and mediastinal lymph nodes due to conditions such as breast cancer, lung cancer, or cancer of the chest wall. The procedure is typically performed alongside another primary procedure. The provider must ensure that the lymphadenectomy is performed in conjunction with the appropriate primary procedure codes listed in the notes.

5. When to use CPT code 38746

CPT code 38746 should be used when the provider performs a thoracic lymphadenectomy by thoracotomy, specifically targeting the removal of mediastinal and regional lymph nodes. It is important to note that this code should only be reported when performed in addition to a primary procedure.

6. Documentation requirements

To support a claim for CPT 38746, the provider must document the following information:

• Patient’s diagnosis necessitating the thoracic lymphadenectomy
• Details of the primary procedure performed
• Specific lymph nodes targeted for removal
• Procedure date and duration
• Any complications or additional procedures performed
• Signature of the performing provider

7. Billing guidelines

When billing for CPT 38746, it is crucial to ensure that the procedure is performed as an add-on to a primary procedure. The provider should report CPT 38746 in addition to the appropriate primary procedure code. It is important to review the notes associated with CPT 38746 to determine the specific primary procedure codes that can be reported alongside it.

8. Historical information

CPT 38746 was added to the Current Procedural Terminology system on January 1, 1994. The code underwent a change on January 1, 2012, with an updated description. It was also added to the Inpatient Only (IPO) list for Medicare in 2017.

9. Examples

1. A surgeon performs a thoracic lymphadenectomy by thoracotomy, removing mediastinal and regional lymph nodes during a procedure to resect a tumor mass in the chest.
2. A patient with lung cancer undergoes a thoracic lymphadenectomy by thoracotomy as part of a comprehensive treatment plan.
3. A provider performs a thoracic lymphadenectomy by thoracotomy, targeting mediastinal and regional lymph nodes, during a surgery to remove a malignant breast tumor.
4. A thoracic surgeon performs a thoracic lymphadenectomy by thoracotomy, removing mediastinal and regional lymph nodes, as part of a procedure to treat cancer of the chest wall.
5. A patient with metastatic cancer undergoes a thoracic lymphadenectomy by thoracotomy to remove affected lymph nodes in the mediastinal and regional areas.
6. A provider performs a thoracic lymphadenectomy by thoracotomy, targeting mediastinal and regional lymph nodes, during a surgery to treat a recurrent tumor in the thoracic region.
7. A thoracic surgeon performs a thoracic lymphadenectomy by thoracotomy, removing mediastinal and regional lymph nodes, as part of a procedure to treat a patient with extensive metastatic breast cancer.
8. A patient with a diagnosis of lung cancer undergoes a thoracic lymphadenectomy by thoracotomy to remove mediastinal and regional lymph nodes for staging purposes.
9. A provider performs a thoracic lymphadenectomy by thoracotomy, targeting mediastinal and regional lymph nodes, during a surgery to treat a patient with advanced esophageal cancer.