Compare 38571-38573 Lymphadenectomy Codes At-a-Glance to Avoid Cutting Reimbursement in Half

If you’re already familiar with laparoscopic bilateral total pelvic lymphadenectomy codes 38571 and 38572, you know the pattern. The second code descriptor builds on the first. When the CPT® 2018 code set added 38573, the new code descriptor followed that pattern, adding quite a few more requirements before you use the new code.

Not sure what I mean? Check out these bullet lists based on the code descriptors, and note the similarities in the first few bullets as well as differences:

38571

  • bilateral total pelvic lymphadenectomy

38572

  • bilateral total pelvic lymphadenectomy
  • peri-aortic lymph node sampling (biopsy), single or multiple

38573

  • bilateral total pelvic lymphadenectomy
  • peri-aortic lymph node sampling
  • peritoneal washings
  • peritoneal biopsy(ies)
  • omentectomy
  • diaphragmatic washings
  • including diaphragmatic and other serosal biopsy(ies), when performed.

What’s the Same on MPFS?

When you check the Medicare Physician Fee Schedule (MPFS) for these three codes, you’ll notice some similarities. Here are some of the most important ones.

Global period: All three codes have a 10-day global period, so be sure you apply the rules for 10-day rather than 90-day or some other global period.

Multiple procedure: The multiple procedure rule applies to these codes. Here’s an abbreviated definition of multiple procedure indicator 3, which the MPFS currently assigns to all three codes: “Special rules for multiple endoscopic procedures apply if procedure is billed with another endoscopy in the same family (i.e., another endoscopy that has the same base procedure) … Payment for the base procedure is included in the payment for the other endoscopy.”

Endo base code: The endoscopic base code for all three codes is separate procedure code 49320 (Laparoscopy, abdomen, peritoneum, and omentum, diagnostic, with or without collection of specimen(s) by brushing or washing (separate procedure)).

Bilateral indicator: The code descriptors specify “bilateral,” so you should not be surprised that the bilateral indicator is 2, which means the 150 percent payment adjustment for a bilateral service doesn’t apply. The RVUs are already based on the procedure being performed bilaterally. (If the surgeon doesn’t remove lymph nodes bilaterally, consider whether appending modifier 52 (Reduced services) to your code is the appropriate choice.)

Bonus tip: The MUE for these codes is 1, meaning the limit on reporting the code for the patient is once per day.

What’s Different on MPFS?

The most complex code, 38573, pays nearly twice as much as simplest code 38571, bringing home the point that clear documentation of all elements performed is essential to accurate coding and payment for bilateral total pelvic lymphadenectomy (just as it is for every service, right?).

Here are the numbers:

  • 38571: With 19.23 RVUs, the simplest code, 38571, brings in roughly $692.27. That’s the national Medicare rate on the MPFS.
  • 38572: With 26.75 total RVUs, the national fee for 38572 is $962.99.
  • 38573: Remember the long list of services in new code 38573? All together, they get 33.59 total RVUs. Multiplied by the current conversion factor, that’s about $1,209.23.

What About You?

Were you glad to see 38573 added to the CPT® code set?

About 

Deborah works on a wide range of TCI SuperCoder projects, researching and writing about coding, as well as assisting with data updates and tool development for our online coding solutions. Since joining TCI in 2004, she’s covered the ins and outs of coding for radiology, cardiology, oncology and hematology, orthopedics, audiology, and more.

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