38571

Laparoscopy, surgical; with bilateral total pelvic lymphadenectomy and peri-aortic lymph node sampling (pelvic and para-aortic lymph nodes)

CPT code 38571 describes a minimally invasive surgical procedure performed using a laparoscope. This involves a bilateral total pelvic lymphadenectomy, meaning the complete removal of lymph nodes from both sides of the pelvis, and peri-aortic lymph node sampling, which entails taking tissue samples from lymph nodes located around the aorta. The procedure is typically undertaken for cancer staging and treatment, to determine the extent of disease spread to regional lymph nodes in the pelvic and retroperitoneal areas. It utilizes small incisions, a camera, and specialized instruments to visualize, dissect, and remove or sample the targeted lymph nodes.

Clinical Indications

  • Staging of pelvic malignancies such as prostate cancer, endometrial cancer, cervical cancer, bladder cancer, or rectal cancer, to assess lymph node involvement.
  • Therapeutic removal of known or suspected metastatic lymph nodes in the pelvic and para-aortic regions.
  • Prognostic assessment for various cancers based on lymph node status.
  • Diagnostic evaluation of enlarged or suspicious lymph nodes in the pelvis or peri-aortic area for malignancy.
  • As part of comprehensive surgical treatment for gynecological or urological cancers.

Procedure Steps

  1. Patient positioning, administration of general anesthesia, and preparation of the surgical field.
  2. Creation of pneumoperitoneum by insufflating carbon dioxide into the abdominal cavity.
  3. Placement of trocars (small ports) to introduce the laparoscope and surgical instruments.
  4. Identification of anatomical landmarks and meticulous dissection to expose the pelvic lymph node basins.
  5. Systematic removal of lymph nodes from both sides of the pelvis, including but not limited to obturator, external iliac, internal iliac, and common iliac regions.
  6. Identification and sampling of peri-aortic (para-aortic) lymph nodes.
  7. Achieving hemostasis (control of bleeding) and irrigation of the surgical field.
  8. Removal of resected lymph node specimens through a trocar site for pathological examination.
  9. Removal of laparoscopic instruments, desufflation of the abdominal cavity, and closure of trocar incisions.

Coding Guidelines

  • CPT code 38571 describes a *bilateral* procedure, therefore modifier 50 (Bilateral Procedure) should NOT be appended to this code.
  • This code specifically includes peri-aortic lymph node *sampling*. If a more extensive or complete para-aortic lymphadenectomy is performed beyond sampling, it may be separately reportable with an appropriate additional code, if supported by medical necessity and documentation, and if not considered inclusive by NCCI edits.
  • This code reflects a laparoscopic approach. Open surgical lymphadenectomies in these regions would be reported with different CPT codes (e.g., from the 387XX series).
  • Diagnostic laparoscopy performed immediately prior to and as an integral part of this therapeutic procedure is generally considered inclusive and not separately reportable.
  • Documentation must clearly specify the extent of the lymphadenectomy (bilateral pelvic and peri-aortic sampling), the indication for the procedure, and the pathology findings.

Associated ICD-10 Codes