Retroperitoneal lymph node dissection (RPLND) is an important surgical option for men with testis cancer. Tamhankar AS, Patil SR, Ojha SP, Ahluwalia P, Gautam G. J Robot Surg. Open RPLND (O-RPLND) has long been the standard approach for lymphadenectomy, but is associated with significant morbidity. The rates of anejaculation are higher for post-chemotherapy RPLND as the nerves cannot always be spared to remove cancer. HR Mittakanti has no conflicts of interest to declare. and transmitted securely. This site needs JavaScript to work properly. The action you just performed triggered the security solution. When you submit an unlisted code, suggest a fee by comparing the procedure your surgeon completed to a similar procedure with a "real" CPT code and an established reimbursement value. Please include what you were doing when this page came up and the Cloudflare Ray ID found at the bottom of this page. The patient underwent comprehensive surgical staging procedures, including total abdominal hysterectomy and bilateral salpingo-oophorectomy, supracolic omentectomy and selective para-aortic lymphadenectomy. It may not display this or other websites correctly. Clipboard, Search History, and several other advanced features are temporarily unavailable. In stage II disease, residual tumors after chemotherapy have to be removed surgically. Bethesda, MD 20894, Web Policies Results: When mapping fails and a complete groin dissection is performed the bundled vulvectomy and lymphadenectomy code would be used in addition to the +38900 (-50) if bilateral. However, bleeding from the aorta or vena cava can require blood transfusion and be potentially life-threatening. American Hospital Association ("AHA"). These risks can include: Retroperitoneal lymph node dissection (RPLND) is used to both diagnose (staging) and treat cancer. eCollection 2023 Feb. Grenabo Bergdahl A, Mnsson M, Holmberg G, Fovaeus M. BJUI Compass. 2020 Translational Andrology and Urology. (Note: CPT code 50545 is still appropriate if they are removed. Find more COVID-19 testing locations on Maryland.gov. In this case, benchmark with 38780 (Retroperitoneal transabdominal lymphadenectomy, extensive, including pelvic, aortic, and renal nodes [separate procedure]), an open retroperitoneal node resection. With the latest advances in robotic technology, one can perform a full bilateral dissection without needing to reposition the patient or redock the robot. Keywords: Recovery can take as long as two to four weeks before feeling 100%. It is important to note this code does not involve the removal of the nodes, only the intraoperative identification or mapping. Serious complications are rare (less than 2%) and include: The nerves that control ejaculation (expulsion of fluid from the penis during orgasm) lie in the retroperitoneum. It has proved feasible also after chemotherapy. It may not display this or other websites correctly. shall not be reported for the excision of lymph nodes that are in the operative field of another surgical procedure. and para-aortic lymph node sampling (biopsy), with removal of tube(s) and ovary(s), if performed 58550 Laparoscopy, surgical, with vaginal hysterectomy (LAVH), for uterus 250 g or less 58552: Laparoscopy, surgical, with vaginal hysterectomy (LAVH), for uterus 250 g or less; with removal of tube(s) and/or ovary(s) eCollection 2018. Most post-chemotherapy RPLNDs are performed in a team approach, with vascular, general and thoracic surgeons available on a case-by-case basis. Retroperitoneal paraaortic lymph node metastases were the only extrapelvic dissemination of OCS. Retroperitoneal Lymph Node Dissection (RPLND). There are many applicable codes here and just as with uterine cancer the sentinel node mapping code can be added when mapping fails but is attempted. Procedure by method 128927009. Stephen H. Bush II, MD, is a gynecologic oncologist with Charleston Area Medical Center in Charleston, WV. National Library of Medicine The site is secure. You should report code 58210 (Radical abdominal hysterectomy, with bilateral total pelvic lymphadenectomy and para-aortic lymph node sampling (biopsy), with or without removal of tube (s), with or without removal of ovary (s)) and 58825 (Transposition, ovary (s)). SNOMED CT Concept 138875005. Accessibility Typically 2-4 nodes. The Medicare Physician Fee Schedule does not include unlisted procedure codes, so the codes do not have assigned fees or global periods. Procedure 71388002. Online ahead of print. To learn more about the laparoscopic RPLND procedure, you may view this video presentation. Testicular cancer has a very high survival rate. Purpose: Retroperitoneal lymph node dissection is the most sensitive and specific diagnostic modality for detecting occult lymph node metastases in clinical stage I testicular tumor. Would it be 38564, 38747, or 38780? Use simple, straightforward language to explain exactly what the urologist did, and why an unlisted code fits best. It is important to clearly document in the operative note the technique that was used, such as what lymphatic basins were explored and their borders and what was injected. Unable to load your collection due to an error, Unable to load your delegates due to an error. All other patients have remained free of relapse. The renal vessels represent the upper limit of template dissection. Steiner H, Leonhartsberger N, Stoehr B, Peschel R, Pichler R. Eur Urol. Your retroperitoneal (REH-troh-PAYR-ih-toh-NEE-ul) lymph nodes are found in the area between your kidneys along a vein (your vena cava) and an artery (your aorta) (see Figure 1). Postchemotherapy laparoscopic retroperitoneal lymph node dissection for low-volume, stage II, nonseminomatous germ cell tumor: first 100 patients. This procedure can prevent the spread of cancer to other parts of the body by removing the lymph nodes. Transl Androl Urol. Other structures the surgeon may need to remove can include: Right after RPLND, your doctor will place a drain in your abdomen to get rid of any extra fluid. The PubMed wordmark and PubMed logo are registered trademarks of the U.S. Department of Health and Human Services (HHS). The aim of our prospective SLIM study was to investigate the incidence of SLN metastases and the contribution of SLN mapping in the management of presumed low- and intermediate-risk EC, i.e., clinical early-stage EC, endometrioid histology, grade 1 or 2. Conclusions: This site needs JavaScript to work properly. Removal of bladder and lymph nodes on both sides of pelvis with transplantation of ureters to small or large bowel with creation of urinary opening 51596 . Epub 2019 Jan 17. da Vinci Xi port placement configuration. Int Braz J Urol. Eur Urol Open Sci. Retroperitoneal lymph node dissection (RPLND) can been employed as primary treatment for stage I non-seminomatous germ cell tumor (NSGCT) as well as for treatment of post-chemotherapy masses. We employ laparoscopic surgical techniques for RPLND, performing the exact dissection and removal of the lymph nodes that is done as an open surgical procedure. You are using an out of date browser. National Library of Medicine In these cases, the retroperitoneal mass can be a viable tumor (1015%) or teratoma (4050%). Texas Subscriber Answer: You should report CPT 38589 ( Unlisted laparoscopic procedure, lymphatic system) as there is no specific CPT code for this laparoscopic procedure. An official website of the United States government. 8600 Rockville Pike Over this period a single retroperitoneal recurrence was observed (stage I), which, however, was not due to surgical failure, but to false negative histologic findings. You should report CPT 38589 (Unlisted laparoscopic procedure, lymphatic system) as there is no specific CPT code for this laparoscopic procedure. During the procedure, your surgeon will make a cut into the abdomen to remove lymph nodes on the same side as the affected testicle. Dr. R. Sherburne Figenshau and Dr. Sam Bhayani specialize in this procedure. Although coders mostly [], You'll Be Spared a 27 Percent Pay Cut -- At Least Until the End of February, At nearly the last minute, Congress votes to boost conversion factor.Although the government appeared poised [], Figure Out Which 5010 Category Your Practice Falls Under, Watch out: Not everyone will have until March 31 to comply.You thought you wouldn't face [], Reposition Your Return to OR Coding With Modifiers, Question:A patient had an artificial urinary sphincter inserted and later on that night, leaned over [], Question:Which is the correct code for a laparoscopic retroperitoneal lymph node dissection (periaortic and interaortocaval [], Question:We have a patient that previously had a creation of a Mitrofanoff and closure of [], Choose 50544 For a Robotic UPJ Obstruction Repair, Question:How would I code a robotic ureteropelvic junction repair?Florida SubscriberAnswer:You should report, Save Time-Based E/M for Counseling/Coordination Heavy Visits, Question:If the physician documents: "Time spent in the evaluation of the patient with mostly medical [], Report Two Codes for Combined, Not Converted Procedure, Question:My urologist does what he calls a robotic assisted nephroureterectomy. Template dissection limits for left-sided tumors consist of ureter (lateral), midpoint of vena cava (medial), bifurcation of iliac vessels (distal) and renal hilum (superior). Safely removing the cancerous lymph nodes involves precise dissection and often removal of adjacent organs rather than risk of major vascular or bowel injury. RPLND was a mainstay of therapy for clinical stage I non-seminomatous germ cell tumors (NSGCT) as it better staged disease and offered a therapeutic benefit for many patients. I am having trouble on what CPT code to benchmark the lymph node dissection to. This procedure removes lymph nodes located in the retroperitoneal section of the bodya space behind the organs in the abdomen. Urologists have historically favored a retroperitoneal approach (RLN . In the setting of testicular tumors, RPLND may be used as a primary treatment modality for low-volume nonseminomatous germ cell . To report an open radical nephrectomy, use CPT code 50230 Nephrectomy, including partial ureterectomy, any open approach including rib resection; radical, with regional lymphadenectomy and/or vena caval thrombectomy. If the left testicle is affected, the lymph nodes on the left side of the abdomen will be removed. Depending on the size of the tumor and complexity of the repair, a vascular surgeon may be a part of the operative team. -50 modifier can be appended for bilateral mapping. Accessibility Retroperitoneal lymph node dissection (RPLND) is used to both stage cancer and prevent it from spreading by removing the lymph nodes. This code can be used if a regional lymphadenectomy and vena caval thrombectomy are performed as well. You must log in or register to reply here. Filing electronically proves you submitted the claim in a timely manner. Contact the AUA Coding Hotline at 1-866-746-4282 (selection option 3) or email us at CodingHotline@AUAnet.org. 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