Apply Lymphatic Coding Rules - Certified Professional Coder CPC

1. A surgeon performs drainage of a lymphocele following a pelvic lymph node dissection. Which CPT® code range is appropriate for lymphocele drainage?
   Answer: 38300-38382 CPT® codes 38300-38382 cover drainage of lymph node abscesses and lymphocele procedures. Code 38300 covers drainage of a lymph node abscess or lymphocele, simple; 38305 covers extensive drainage. These codes cover percutaneous or open drainage of lymphatic fluid collections. The lymphocele drainage is distinct from lymph node biopsy or dissection procedures.
2. The operative report documents autologous bone marrow harvest for transplantation. Which CPT® code covers this harvest procedure?
   Answer: 38232 CPT® 38230 covers bone marrow harvesting for transplantation, allogeneic. Code 38232 covers autologous bone marrow harvesting. For an autologous harvest (the patient's own marrow harvested for later reinfusion), 38232 is the specific code. Code 38230 is for allogeneic harvest (from a donor). The distinction between autologous and allogeneic drives code selection.
3. A surgeon performs a complete splenectomy via laparotomy. Which CPT® code range covers splenectomy procedures?
   Answer: 38100-38120 CPT® codes 38100-38120 cover spleen procedures. Code 38100 covers splenectomy, total (separate procedure); 38101 covers splenectomy, partial; 38120 covers laparoscopic splenectomy. The spleen is part of the hemic and lymphatic system in CPT® coding.
4. A surgeon performs a pelvic lymph node dissection as part of a radical prostatectomy for prostate cancer. Is the pelvic lymphadenectomy separately reportable?
   Answer: Yes — pelvic lymph node dissection performed with radical prostatectomy is separately reportable Pelvic lymph node dissection (CPT® 38562 — limited pelvic and para-aortic lymphadenectomy, or 38571 — laparoscopic pelvic lymph node dissection) performed in conjunction with radical prostatectomy is separately reportable. CPT® guidelines and the prostatectomy code descriptors indicate that lymph node dissection is not included in the primary prostatectomy code and may be reported in addition.
5. A surgeon performs a modified radical neck dissection, preserving the sternocleidomastoid muscle, internal jugular vein, and spinal accessory nerve, while removing cervical lymph nodes. Which CPT® code is most appropriate?
   Answer: 38724 CPT® 38724 covers cervical lymphadenectomy (modified radical neck dissection). The preservation of key structures — sternocleidomastoid muscle, internal jugular vein, or spinal accessory nerve — distinguishes a modified radical neck dissection (38724) from a complete/radical dissection (38720). Documentation of which structures are preserved drives the code selection.
6. A patient is seen for evaluation of swollen cervical lymph nodes. The physician documents "reactive lymphadenopathy." Which ICD-10-CM code captures this condition?
   Answer: R59.1 ICD-10-CM R59.1 covers generalized enlarged lymph nodes; R59.0 covers localized enlarged lymph nodes. For localized cervical lymphadenopathy documented as reactive, R59.0 is appropriate. L04.0 covers acute lymphadenitis of face, head, and neck (infectious/inflammatory — more specific). C77.0 is secondary malignant neoplasm of lymph nodes of head and neck — not appropriate for benign reactive lymphadenopathy.
7. A patient is seen for chronic lymphedema of the left lower extremity following lymph node dissection for ovarian cancer treatment. Which ICD-10-CM code is reported for the lymphedema?
   Answer: I89.0 ICD-10-CM I89.0 covers lymphedema, not elsewhere classified, and is the appropriate code for chronic lymphedema following lymph node dissection that is not related to mastectomy. Code I97.2 (postmastectomy lymphedema syndrome) is specifically restricted to lymphedema occurring as a consequence of mastectomy — it does not apply to lymphedema following other lymph node dissections such as those performed for ovarian cancer staging or treatment. Q82.0 is hereditary lymphedema; I89.1 is lymphangitis, not lymphedema.
8. During a laparoscopic splenectomy, the surgeon inadvertently injures the splenic hilum and must convert to an open splenectomy to complete hemostasis. Which CPT® code is reported?
   Answer: 38100 When a laparoscopic procedure is converted to an open procedure, only the open procedure code is reported. CPT® 38100 (splenectomy, total, open) is the correct code. The laparoscopic attempt is not separately reported. This is consistent with the general CPT® guideline that conversion to open surgery is reported with the open procedure code only.
9. A surgeon performs a laparoscopic splenectomy for a patient with immune thrombocytopenic purpura (ITP). Which ICD-10-CM code captures ITP?
   Answer: D69.41 ICD-10-CM D69.41 covers immune thrombocytopenic purpura (ITP). D69.3 covers immune thrombocytopenia; D69.6 covers thrombocytopenia, unspecified. The specific code D69.41 distinguishes ITP from other thrombocytopenias and is the most precise code when ITP is documented. Splenectomy for ITP is one of the most common surgical indications captured by this code.
10. A patient undergoes lymphangiography of the abdominal/pelvic lymphatics. Which CPT® code range covers lymphangiography procedures?
    Answer: 75801–75807 CPT® codes 75801–75807 cover lymphangiography in the Radiology section. Code 75801 covers lymphangiography, extremity only, bilateral; 75805 covers pelvic and/or abdominal; 75807 covers thoracic. These are radiological imaging codes, not surgical procedure codes. Lymphangiography is a radiology service despite involving the lymphatic system.
11. A surgeon performs a radical neck dissection for squamous cell carcinoma of the tongue, removing lymph nodes from the ipsilateral neck. Which CPT® code covers a radical neck dissection?
    Answer: 38720 CPT® 38720 covers cervical lymphadenectomy (complete). Code 38700 covers superficial cervical lymphadenectomy; 38724 covers cervical lymphadenectomy (modified radical neck dissection). Code 38720 is the complete (radical) dissection. The extent of the dissection — superficial, modified radical, or radical — determines the correct code within the cervical lymphadenectomy range.
12. A surgeon performs an axillary lymph node dissection as part of a modified radical mastectomy. Is the axillary lymph node dissection separately reportable?
    Answer: No — axillary lymph node dissection is included in the modified radical mastectomy code and is not separately reportable The modified radical mastectomy CPT® code (19307) includes removal of breast tissue along with axillary lymph node dissection as an integral component of the procedure. The axillary dissection is not separately reported when performed as part of the modified radical mastectomy. Reporting both constitutes unbundling.
13. A surgical pathologist examines a lymph node dissection specimen containing 18 lymph nodes. Which CPT® surgical pathology code level applies to lymph node dissection specimens?
    Answer: 88307 CPT® 88307 covers level V surgical pathology, which includes lymph node dissection specimens. Lymph node dissection specimens are classified at the level V (88307) due to their complexity and the level of pathologic examination required. Levels are determined by the type of tissue and the complexity of examination, not the number of nodes in the specimen.
14. A patient with sickle cell disease develops splenic sequestration crisis requiring emergent splenectomy. Which ICD-10-CM category covers sickle cell disease?
    Answer: D57 ICD-10-CM category D57 covers sickle cell disorders. Specific subcategories distinguish sickle cell disease (D57.0-D57.2), sickle cell trait (D57.3), and other sickle cell disorders (D57.8). The acute splenic sequestration would be captured in the specific sickle cell disease code (e.g., D57.02 — sickle cell disease with splenic sequestration). Accurate subcategory selection requires documentation of the specific sickle cell crisis type.
15. A bone marrow aspiration is performed on a patient with suspected leukemia. Which CPT® code covers bone marrow aspiration?
    Answer: 38220 CPT® 38220 covers diagnostic bone marrow aspiration(s). Code 38221 covers diagnostic bone marrow biopsy (biopsy needle). Code 38222 covers bone marrow biopsy and aspiration performed together. Code 38230 covers bone marrow harvesting for transplantation. Aspiration alone vs. biopsy alone vs. combined aspiration and biopsy are separately defined CPT® services.
16. A pathologist performs intraoperative consultation on a lymph node specimen using frozen section analysis. Which CPT® code covers this intraoperative pathology service?
    Answer: 88331 CPT® 88331 covers pathologic examination of a surgical specimen using frozen section technique, first tissue block. Intraoperative frozen section consultation allows the surgeon to receive real-time pathologic feedback during the procedure. Code 88329 covers consultation during surgery — pathologic examination, gross and microscopic. Code 88300 and 88302 are for routine surgical pathology, not frozen sections.
17. A surgeon performs an open biopsy of a single cervical lymph node. Which CPT® code range covers lymph node biopsy procedures?
    Answer: 38500-38530 CPT® codes 38500-38530 cover biopsy or excision of lymph nodes. Code 38500 covers open biopsy of a superficial lymph node (e.g., cervical, axillary, inguinal). Code 38505 covers needle core biopsy of a lymph node. The 38700 range covers radical neck dissection procedures, not simple biopsy.
18. A patient is diagnosed with secondary malignant neoplasm of a lymph node — a metastasis from a primary lung cancer. How are these conditions coded in ICD-10-CM?
    Answer: C34 series for the primary lung cancer first; then C77 series for the lymph node metastasis Per ICD-10-CM Official Guidelines, when a patient has both a primary malignancy and a metastatic site, the primary malignancy is sequenced first unless treatment is directed solely at the metastatic site. C34 (malignant neoplasm of bronchus and lung) is followed by C77 (secondary and unspecified malignant neoplasm of lymph nodes). The lymph node involvement category and subcode reflect the specific lymph node region.
19. A surgeon performs a radical neck dissection as part of the same operative session as a total laryngectomy for laryngeal carcinoma. Can the radical neck dissection be reported separately?
    Answer: Yes — the neck dissection is a separately reportable procedure and may be reported in addition to the laryngectomy A radical neck dissection performed concurrently with a primary head and neck cancer resection (such as laryngectomy) is a separately reportable procedure. CPT® guidelines and NCCI do not bundle the neck dissection into the primary resection. Both the laryngectomy code and the neck dissection code (38720 or 38724) are reported, with modifier -51 on the lower-valued procedure.
20. A patient undergoes a laparoscopic splenectomy. The CPT® description for laparoscopic splenectomy includes "with or without drain placement." Does this mean the drain placement is always separately reportable?
    Answer: No — the code descriptor explicitly includes drain placement, so it is bundled into the laparoscopic splenectomy code When a CPT® code descriptor includes the phrase "with or without" a particular service (such as drain placement), that service is bundled into the primary code regardless of whether it is performed. Reporting a separate code for drain placement in this scenario constitutes unbundling. Always review the full code descriptor before reporting additional codes for components that may be included.

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