How to code for pelvic lymphadenectomy

Which lymph nodes should be included to be considered a "total" pelvic lymphadenectomy/CPT 38571? When should I consider using the unlisted code or adding a –52 modifier?

External iliac, hypogastric, and obturator nodes are all considered a part of a pelvic lymphadenectomy; however, 38571 (Laparoscopy, surgical; with bilateral total pelvic lymphadenectomy) does not specifically delineate which nodes have to be removed. Therefore, 38571 should be used to report all therapeutic pelvic lymphadenectomies with one caveat and one exception.

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The caveat: If the procedure is interrupted for some technical reason and you are unable to complete the procedure, then charge with the –52 modifier. Otherwise, charge without the modifier.

The exception: If peri-aortic lymph nodes sampling is added to the total pelvic lymphadenectomy, then charge 38572 (Laparoscopy, surgical; with bilateral total pelvic lymphadenectomy and peri-aortic lymph node sampling). If the intent is anything other than a total therapeutic lymphadenectomy performed through the laparoscope, you’re probably stuck with the appropriate unlisted code.

In summary, there is no discrete delineation or line to be drawn between groups or number of nodes, only intent and accomplishment.

Next: Can I bill for home health orders during the global period?

I read your very helpful article on global periods. It raises two questions: Can I bill for home health orders during the global period (G0180 for initial certification)? Also, can I bill G0181 for supervision of home health, 30 minutes per month? This has been widely debated here.

The short answer is yes, but only if the services are clearly separate from and in addition to the services required to provide follow-up for the procedure you have provided. Clear documentation of certification or recertification requirements directed at treatment of the full patient, above and beyond the coordination of home health for recovery from the surgery provided, is a must to charge either:

G0180: Physician certification for Medicare-covered home health services under a home health plan of care (patient not present), including contacts with home health agency and review of reports of patient status required by physicians to affirm the initial implementation of the plan of care that meets patient's needs, per certification period;

or G0181: Physician supervision of a patient receiving Medicare-covered services provided by a participating home health agency (patient not present) requiring complex and multidisciplinary care modalities involving regular physician development and/or revision of care plans, review of subsequent reports of patient status, review of laboratory and other studies, communication (including telephone calls) with other health care professionals involved in the patient's care, integration of new information into the medical treatment plan and/or adjustment of medical therapy, within a calendar month, 30 minutes or more.

This answer assumes that the patient is considered eligible for home health benefits and that the physician or billing provider meets the requirements for certifying home health services. (If you are unclear on either of these issues, we recommend you review Medicare the information provided by Medicare from this website: bit.ly/HomeHealthinfo). Regulations are unclear as to whether a modifier would be required to indicate these circumstances; however, it appears that modifier –24 would be appropriate as the circumstances meet the definition.

More from the Painters:

T pellets: What are you allowed to charge?

MIPS: A first look at how it will affect your practice

PQRS success challenging but doable for urologists

The information in this column is designed to be authoritative, and every effort has been made to ensure its accuracy at the time it was written. However, readers are encouraged to check with their individual carrier or private payers for updates and to confirm that this information conforms to their specific rules.

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