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  Lymph node dissection

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Reprinted from October 1993 CAP TODAY

The uniform CPT coding system for surgical pathology specimens published in Physicians Current Procedural Terminology in 1992 in cludes regional lymph node dissection as a Level V (88307) service. However, several Level VI (88309) specimens include regional lymph node dissection. “Breast, Mastectomy--with Regional Lymph Nodes” and “Larynx, Partial/Total Resection--with Regional Lymph Nodes” always are coded as a single service with 88309.

There are other Level VI (88309) services where lymph nodes also may be considered part of the Level VI service, and where regional lymph nodes should not be coded separately.

In general, when lymph nodes are an integral part of a resection specimen, they are not coded separately. For example regional mesenteric lymph nodes removed with a colon resection are a part of that specimen. However, if extended lymph nodes from the periaortic region were submitted separately, these would be coded as 88307 in addition to 88309 for the bowel resection.

In contrast, lymph nodes that may separately accompany many radical resections but are not an integral part of the specimen generally are coded separately. Such resections would include radical prostatectomy, hysterectomy, and/or salpingo-oophorectomy, orchiectomy, vulvectomy, partial or complete urinary cystectomy, glossectomy, tonsillectomy, or bone resection. It should be the responsibility of pathologists familiar with presentation of the specimen in each case to make the coding assignment based on the general policy.