How To Use CPT Code 38770

CPT 38770 describes the surgical excision of lymph nodes in the pelvic area, including the external iliac, hypogastric, and obturator nodes. 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 38770?

CPT 38770 can be used to describe the surgical removal of lymph nodes in the pelvic area, specifically the external iliac, hypogastric, and obturator nodes. This procedure is commonly performed when there is cancer in the lower abdomen that requires the removal of these lymph nodes.

2. Official Description

The official description of CPT code 38770 is: ‘Pelvic lymphadenectomy, including external iliac, hypogastric, and obturator nodes (separate procedure).’ If the procedure is performed bilaterally, modifier 50 should be appended to the code.

3. Procedure

1. The provider begins by making an incision in the lower abdomen, from the umbilicus to the pubis.
2. Once the patient is prepped and anesthetized, the provider explores the pelvis and identifies the external iliac, hypogastric, and obturator lymph nodes.
3. The provider surgically excises these lymph nodes, along with any other involved tissues.
4. In cases of extensive metastatic cancer, it may be necessary to remove all of the lymph nodes in the area of the disease.
5. The provider ensures hemostasis and closes the incision in layers.

4. Qualifying circumstances

CPT 38770 is performed when there is a need to remove the pelvic lymph nodes, including the external iliac, hypogastric, and obturator nodes. This procedure is commonly performed for patients with cancer in the lower abdomen. It is important to note that if the procedure is performed bilaterally, modifier 50 should be appended to the code.

5. When to use CPT code 38770

CPT code 38770 should be used when the provider performs a pelvic lymphadenectomy, specifically removing the external iliac, hypogastric, and obturator nodes. This code should not be reported if the procedure is performed along with a related procedure in the same anatomic area or through the same incision, orifice, or surgical approach. If the procedure is performed with an unrelated procedure, modifier 59 should be appended to the code to indicate that it is a distinct procedural service.

6. Documentation requirements

To support a claim for CPT 38770, the provider must document the following information:

• Patient’s diagnosis and the need for pelvic lymphadenectomy
• Specific lymph nodes removed, including the external iliac, hypogastric, and obturator nodes
• Date of the procedure
• Details of the procedure, including any other involved tissues
• Confirmation of hemostasis and closure of the incision

7. Billing guidelines

When billing for CPT 38770, ensure that the procedure is performed as a separate procedure and not as part of a related procedure. If the procedure is performed with an unrelated procedure, modifier 59 should be appended to the code. It is important to note that modifier 59 should not be confused with modifier 51, which is used for reporting multiple procedures. Documentation must support the use of the modifier.

8. Historical information

CPT 38770 was added to the Current Procedural Terminology system on January 1, 1990. The code has not undergone any updates since its addition. In 2017, it was added to the Inpatient Only (IPO) list for Medicare.

9. Examples

1. A patient with cervical cancer undergoes a pelvic lymphadenectomy, including the external iliac, hypogastric, and obturator nodes.
2. A provider performs a pelvic lymphadenectomy, including the external iliac, hypogastric, and obturator nodes, for a patient with ovarian cancer.
3. A patient with testicular cancer undergoes a pelvic lymphadenectomy, including the external iliac, hypogastric, and obturator nodes.
4. A provider performs a pelvic lymphadenectomy, including the external iliac, hypogastric, and obturator nodes, for a patient with bladder cancer.
5. A patient with prostate cancer undergoes a pelvic lymphadenectomy, including the external iliac, hypogastric, and obturator nodes.
6. A provider performs a pelvic lymphadenectomy, including the external iliac, hypogastric, and obturator nodes, for a patient with rectal cancer.
7. A patient with uterine cancer undergoes a pelvic lymphadenectomy, including the external iliac, hypogastric, and obturator nodes.
8. A provider performs a pelvic lymphadenectomy, including the external iliac, hypogastric, and obturator nodes, for a patient with vulvar cancer.
9. A patient with penile cancer undergoes a pelvic lymphadenectomy, including the external iliac, hypogastric, and obturator nodes.
10. A provider performs a pelvic lymphadenectomy, including the external iliac, hypogastric, and obturator nodes, for a patient with colorectal cancer.