38571

🧬 CPT 38571 — Laparoscopy, Surgical; with Bilateral Total Pelvic Lymphadenectomy

Code Description

Official CPT Description: Laparoscopy, surgical; with bilateral total pelvic lymphadenectomy

CPT 38571 reports a laparoscopic (minimally invasive) surgical procedure in which lymph nodes from both sides of the pelvis are completely excised under direct laparoscopic visualization. This is a total, bilateral, therapeutic lymphadenectomy — meaning the complete regional lymph node packet is removed from both the right and left pelvic basins, as opposed to a limited biopsy or sampling of isolated nodes.

Three critical elements of this code define its appropriate application and distinguish it from related codes in the lymphadenectomy family:

First — Laparoscopic or robotic approach. CPT 38571 applies to any minimally invasive approach, including standard laparoscopy and robotic-assisted laparoscopy (e.g., da Vinci robotic platform). The code does not restrict the technology used; it describes the result and approach category. Open pelvic lymphadenectomy is reported with CPT 38770 (pelvic lymphadenectomy including external iliac and obturator nodes), not 38571.

Second — Bilateral. The code descriptor specifically states bilateral. Bilaterality is inherent in the code — Modifier 50 should not be appended, as it would imply the procedure is unilateral by nature and was performed twice. When only one side is dissected to completion, the appropriate action is to append Modifier 52 (Reduced Services) to 38571, or alternatively to use unlisted laparoscopic code 38589 benchmarked to the reduced value of 38571. Reporting 38571 without a modifier for a unilateral dissection is an overcoding error.

Third — Total lymphadenectomy, not sampling. CPT 38571 is a therapeutic total lymphadenectomy in which the complete bilateral pelvic lymph node packet is removed. Although the code descriptor does not enumerate specific node groups, the accepted definition of a “total pelvic lymphadenectomy” encompasses the bilateral external iliac, internal iliac (hypogastric), and obturator lymph node groups as a minimum. The distinction between 38571 (total bilateral lymphadenectomy) and 38570 (retroperitoneal lymph node sampling) is the completeness and intent of the dissection: a few isolated targeted nodes, sentinel nodes, or suspicious nodes are reported with 38570, while systematic removal of all identifiable regional pelvic nodes is reported with 38571.

Robotic assistance is included. There is no separate CPT code for robotic assistance during pelvic lymphadenectomy. When the procedure is performed robotically, 38571 remains the correct code. The robotic platform is the tool, not a separately billable service at the physician level (though facility-level robotic supply charges may be captured on the UB-04 separately).

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Anatomy & Clinical Context

The pelvic lymph nodes form the primary regional drainage basin for the pelvic organs, including the bladder, prostate, uterus, cervix, ovaries, distal ureter, and distal colon/rectum. They are situated along the major pelvic vessels and are categorized into several clinically important groups:

External iliac nodes run along the external iliac artery and vein, from the inguinal ligament proximally toward the common iliac bifurcation. These nodes receive drainage from the lower extremity lymphatics, groin, and anterior pelvic organs including the bladder dome and anterior uterine body. They are the most anterolateral of the pelvic node groups.

Internal iliac (hypogastric) nodes cluster around the internal iliac artery and its branches. They receive drainage from the deep pelvic organs: the bladder base, posterior uterus, cervix, vagina, rectum, and prostate. They are frequently involved in nodal metastasis from cervical, endometrial, and rectal cancers, and are the most medially and posteriorly situated node group accessed during pelvic lymphadenectomy.

Obturator nodes are located in the obturator fossa, bounded superiorly by the external iliac vein, medially by the obturator nerve and vessels, and laterally by the pelvic sidewall. They are among the most commonly sampled node groups in prostate cancer staging due to their direct drainage from the prostate gland. The obturator nerve, which innervates the medial thigh, runs through the obturator fossa and must be carefully identified and preserved during dissection to avoid post-operative inner thigh weakness or adductor paresthesias.

Common iliac nodes lie along the common iliac vessels, superior to the pelvic brim. When nodes at or above the level of the aortic bifurcation are also removed, this extends the dissection into para-aortic territory and would necessitate upgrading to CPT 38572.

The clinical purpose of bilateral total pelvic lymphadenectomy is dual: surgical staging (determining whether cancer has spread beyond the primary organ to regional lymph nodes) and therapeutic intent (removing all identifiable nodal disease to achieve regional disease control). The staging information obtained from the lymphadenectomy directly influences adjuvant treatment decisions, including the need for radiation therapy, systemic chemotherapy, and hormonal therapy.

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Procedure Overview

Patient Preparation and Positioning: The patient is placed under general anesthesia and positioned in the dorsal lithotomy or supine position, often in steep Trendelenburg (30-45 degrees) to allow gravity to shift the bowel out of the pelvis and improve visualization. Arms are tucked to permit robotic arm positioning.

Port Placement: Trocar access is established using standard laparoscopic or robotic port configurations. Typically, a 12mm umbilical camera port, two or three 8mm robotic instrument ports (for robotic cases), and one or two 5-12mm assistant ports are placed depending on the system used and the concurrent procedures planned.

Exposure: The pelvic peritoneum overlying the external iliac vessels is identified. The round ligament (in female patients) or the spermatic cord (in male patients) serves as the lateral boundary marker. The peritoneum is incised and the retroperitoneum is entered.

Right Pelvic Dissection: The external iliac artery and vein are identified and traced distally to the circumflex iliac vessels and proximally toward the common iliac bifurcation. Lymphoareolar tissue is carefully swept off the vessels using a combination of sharp and blunt dissection, monopolar cautery, bipolar cautery, advanced energy devices (LigaSure, Harmonic), and clip application for larger lymphatic channels. The obturator fossa is entered by identifying the obturator nerve and sweeping the lymphoareolar bundle caudally and medially. The internal iliac artery is identified and the medial node group is swept off the anterior surface of the internal iliac vessels.

Left Pelvic Dissection: The identical dissection is performed on the contralateral side with symmetric technique.

Hemostasis and Closure: All identified lymphatic vessels are clipped or cauterized to reduce the risk of lymphocele formation. Specimens from the right and left sides are placed in separate laparoscopic specimen bags and removed through one of the trocar sites. Ports are removed under direct visualization and trocar sites are closed.

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ICD-10-CM Diagnosis Codes

The following diagnosis codes are the most clinically relevant indications for CPT 38571. Pelvic lymphadenectomy is almost exclusively performed in the context of malignancy — either as part of the initial staging workup or as a therapeutic procedure when nodal disease is confirmed or suspected.

Urologic Malignancies (primary Urology indications)

• C61 — Malignant neoplasm of prostate. Bilateral pelvic PLND is performed concurrently with radical prostatectomy (open, laparoscopic, or robotic) in intermediate- and high-risk prostate cancer for staging purposes and/or therapeutic node removal.
• C67.9 — Malignant neoplasm of bladder, unspecified. Pelvic lymphadenectomy is performed at the time of radical cystectomy for muscle-invasive bladder cancer. The extent of the dissection (standard vs. extended) directly impacts oncologic outcomes.
• C67.0 through C67.8 — Bladder cancer with specific subsite documentation.
• C64.1 / C64.2 / C64.9 — Malignant neoplasm of right/left/unspecified kidney. May be performed at the time of radical nephrectomy with regional node involvement.
• C65.1 / C65.2 / C65.9 — Malignant neoplasm of right/left/unspecified renal pelvis. Nephroureterectomy with PLND for upper tract urothelial carcinoma.
• C66.1 / C66.2 / C66.9 — Malignant neoplasm of right/left/unspecified ureter.
• C62.90 through C62.92 — Malignant neoplasm of testis (clinical stage II or beyond with pelvic nodal involvement, though inguinal/retroperitoneal node dissection is more typical for testicular cancer).
• C60.9 — Malignant neoplasm of penis. Pelvic lymphadenectomy for penile cancer with inguinal node involvement that has extended to pelvic nodes.

Gynecologic Malignancies (primary GYN-Oncology indications)

• C54.1 — Malignant neoplasm of endometrium. Laparoscopic staging for endometrial carcinoma is one of the highest-volume indications for 38571. Bilateral pelvic PLND is performed as part of the comprehensive surgical staging of endometrial cancer, along with hysterectomy and bilateral salpingo-oophorectomy.
• C54.2 / C54.3 / C54.8 / C54.9 — Other endometrial/uterine body malignancies.
• C53.0 / C53.1 / C53.8 / C53.9 — Malignant neoplasm of cervix uteri. Pelvic lymphadenectomy is a key component of radical hysterectomy staging for cervical cancer (stage IB-IIA).
• C56.1 / C56.2 / C56.9 — Malignant neoplasm of ovary. Staging for ovarian carcinoma includes pelvic lymphadenectomy as part of comprehensive surgical staging.
• C57.00 / C57.01 / C57.02 — Malignant neoplasm of fallopian tube.
• C51.0 / C51.1 / C51.9 — Malignant neoplasm of vulva. Advanced vulvar cancer with suspected pelvic nodal extension.

Secondary/Metastatic Nodal Disease

• C77.5 — Secondary and unspecified malignant neoplasm of intrapelvic lymph nodes. When the primary tumor has already been treated and the procedure is being performed specifically to address metastatic pelvic nodal disease.

Staging Without Confirmed Malignancy In some cases, 38571 is performed when malignancy is highly suspected but not yet pathologically confirmed (e.g., high-grade biopsy prompting staging prior to definitive surgical treatment). In these scenarios, use the primary neoplasm code if a confirmed diagnosis exists, or the appropriate “uncertain behavior” or “in situ” code if confirmation is pending at the time of the procedure.

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ICD-10-PCS Crosswalk (Inpatient Facility)

In the inpatient setting, ICD-10-PCS codes replace CPT codes on all claims. The correct PCS coding for laparoscopic pelvic lymphadenectomy uses the Medical and Surgical (0) section, Lymphatic and Hemic Systems (7) body system.

Critical PCS Root Operation Decision — Excision (B) vs. Resection (T):

This is the most important coding decision in PCS for lymph node procedures. ICD-10-PCS Guideline B3.2b and the unique anatomy of the lymphatic system create a nuanced rule:

• Excision (B) is used when a portion of a body part is removed. For lymph nodes, “Pelvis Lymphatic” (body part C) is treated as a single body part that encompasses the entire regional pelvic lymph node basin. When some pelvic nodes are removed — even if described clinically as a “complete” pelvic lymphadenectomy — this is coded as Excision because the body part (the entire lymphatic system of the pelvis) is not entirely removed.
• Resection (T) is used when the entire body part is removed. Resection of the pelvis lymphatic (07TC) would only apply if absolutely every lymph node and lymphatic channel within the pelvic body part was removed — a scenario that almost never occurs in clinical practice.

In practice, virtually all pelvic lymphadenectomy procedures — including what is clinically described as a “total” bilateral pelvic lymphadenectomy — are coded with the Excision (B) root operation in ICD-10-PCS, not Resection. The qualifier character (ZX = diagnostic/biopsy; ZZ = therapeutic) distinguishes a staging-only procedure from a therapeutic complete dissection.

Qualifier X (Diagnostic) vs. Qualifier Z (No Qualifier — Therapeutic):

• X (Diagnostic) applies when the lymph nodes are removed specifically and solely for diagnostic/staging purposes, with no therapeutic intent. Sentinel node biopsy and pure staging lymphadenectomies typically use qualifier X.
• Z (No Qualifier) applies when the lymphadenectomy is therapeutic — i.e., removing lymph nodes known or believed to harbor metastatic disease, or as a definitive staging and treatment procedure during cancer surgery.

In practice, most complete bilateral pelvic lymphadenectomies performed concurrently with radical prostatectomy, cystectomy, or hysterectomy are coded with 07BC4ZZ (Excision of Pelvis Lymphatic, Percutaneous Endoscopic, no qualifier), as the intent is both staging and therapeutic.

Primary ICD-10-PCS Codes for CPT 38571:

• 07BC4ZZ — Excision of Pelvis Lymphatic, Percutaneous Endoscopic Approach. The primary PCS code for laparoscopic or robotic total bilateral pelvic lymphadenectomy performed with therapeutic/complete intent.
• 07BC4ZX — Excision of Pelvis Lymphatic, Percutaneous Endoscopic Approach, Diagnostic. Used when the pelvic PLND is explicitly a staging/biopsy procedure without therapeutic intent.
• 07BC0ZZ — Excision of Pelvis Lymphatic, Open Approach. Used for open pelvic lymphadenectomy; does NOT correspond to CPT 38571 (which is laparoscopic only) but rather to CPT 38770.
• 07BC0ZX — Excision of Pelvis Lymphatic, Open Approach, Diagnostic. Open lymph node sampling or biopsy.
• 07TC4ZZ — Resection of Pelvis Lymphatic, Percutaneous Endoscopic Approach. Reserved for the extremely rare scenario where the entire pelvic lymphatic body part is resected. Almost never appropriate.
• 07TC0ZZ — Resection of Pelvis Lymphatic, Open Approach. Similarly reserved for complete resection scenarios.

Bilateral PCS Coding:

ICD-10-PCS does not have a bilateral body part value for the pelvis lymphatic (body part C is already defined as the pelvis lymphatic region, encompassing both sides). Accordingly, a bilateral pelvic lymphadenectomy is typically reported with a single PCS code (07BC4ZZ), unless the laterality and approach are distinctly different on each side. Coding both a right and left code separately would require documentation supporting separate operative approaches or distinct body part values, which do not exist at this anatomic level in PCS.

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MS-DRG Assignment

CPT 38571 / ICD-10-PCS 07BC4ZZ are nearly always performed as companion procedures to a primary major oncologic surgery, rather than as standalone inpatient procedures. The DRG assignment in the inpatient setting is therefore driven primarily by the principal procedure (the most resource-intensive OR procedure that most directly addresses the principal diagnosis), with the lymphadenectomy serving as an additional OR-designated procedure that may or may not independently change the DRG.

Key Point for Inpatient Coders: ICD-10-PCS 07BC4ZZ is designated as an OR procedure in the MS-DRG grouper. Its presence on a claim will trigger a surgical DRG. However, since it is almost universally accompanied by a higher-weight primary procedure, the DRG in practice is driven by that primary procedure’s MDC classification.

Gynecologic Oncology DRGs (MDC 13 — Female Reproductive System):

• MS-DRG 736 — Uterine and Adnexa Procedures for Ovarian or Adnexal Malignancy with MCC
• MS-DRG 737 — Uterine and Adnexa Procedures for Ovarian or Adnexal Malignancy with CC
• MS-DRG 738 — Uterine and Adnexa Procedures for Ovarian or Adnexal Malignancy without CC/MCC
• MS-DRG 742 — Uterine and Adnexa Procedures for Non-Malignancy with CC/MCC
• MS-DRG 743 — Uterine and Adnexa Procedures for Non-Malignancy without CC/MCC
• MS-DRG 734 — Pelvic Evisceration, Radical Hysterectomy and Radical Vulvectomy with CC/MCC
• MS-DRG 735 — Pelvic Evisceration, Radical Hysterectomy and Radical Vulvectomy without CC/MCC

Urologic DRGs (MDC 11 — Kidney and Urinary Tract): When the principal procedure is cystectomy or radical nephrectomy with concurrent pelvic PLND:

• MS-DRG 673 — Other Kidney and Urinary Tract Procedures with MCC
• MS-DRG 674 — Other Kidney and Urinary Tract Procedures with CC
• MS-DRG 675 — Other Kidney and Urinary Tract Procedures without CC/MCC
• MS-DRG 663 — Minor Bladder Procedures with MCC
• MS-DRG 670 — Transurethral Procedures with MCC

Male Reproductive DRGs (MDC 12): When the principal procedure is radical prostatectomy with concurrent PLND:

• MS-DRG 756 — Male Reproductive System O.R. Procedures for Malignancy with MCC
• MS-DRG 757 — Male Reproductive System O.R. Procedures for Malignancy with CC
• MS-DRG 758 — Male Reproductive System O.R. Procedures for Malignancy without CC/MCC

When Pelvic PLND Is Performed as the Sole Inpatient Procedure: This is an uncommon but not impossible scenario (e.g., restaging lymphadenectomy after prior primary treatment). In this case, the DRG would be determined by the principal diagnosis (malignancy code) and the lymphadenectomy as the sole OR procedure. The most likely groups would be MDC-specific surgical DRGs for the malignancy’s organ system.

Impact of CC/MCC Capture: Because so many pelvic PLND cases involve malignancy with treatment-related complications, organ involvement, and significant comorbidities, meticulous capture of CCs and MCCs (e.g., malnutrition, anemia requiring transfusion, ileus, lymphedema, coagulopathy, diabetes with complication) has a direct and meaningful impact on DRG weight and facility reimbursement. Always review the entire medical record for secondary diagnoses that qualify as CCs or MCCs in oncology inpatient cases.

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wRVU and Reimbursement

• Work RVU (wRVU): 14.76
• Total RVU (national average): approximately 19.23
• Global Period: 10 days (not 90 days and not 0 days — this is a frequently overlooked distinction)
• Approximate 2025 Medicare Payment (facility): ~$622-$692 based on national averages
• Medicare Conversion Factor 2025: $32.35
• Anesthesia Code Crosswalk: 00840 (Anesthesia for intraperitoneal procedures in lower abdomen including laparoscopy; not otherwise specified) — 7 base units

The 10-day global period deserves emphasis because it falls between the familiar 0-day and 90-day global period categories and is sometimes confused with one or the other. Under a 10-day global:

• The day of surgery and the 9 days following are included in the global period.
• Post-operative E/M visits within those 10 days by the performing surgeon for reasons related to the surgery are included in the surgical fee and cannot be billed separately.
• E/M visits during the global period for unrelated conditions are separately billable with Modifier 24.
• Starting on day 11 post-operatively, E/M visits by the performing surgeon are freely separately billable without any modifier.
• Complications requiring a return to the OR during the 10-day global period require Modifier 78 (unplanned return to OR for related procedure during postoperative period).

The 2016 CMS physician fee schedule update reduced RVU values for 38570-38572 by between 5.5% and 16.3% relative to prior rates, which significantly impacted gynecologic oncology and urology practice reimbursement for these codes. Despite the cuts, 38571 remains among the higher-wRVU laparoscopic procedure codes available in the pelvic surgery space, reflecting the technical complexity of complete bilateral pelvic node dissection.

Comparison within the laparoscopic lymphadenectomy family:

• 38570 (retroperitoneal sampling) — wRVU approximately 9.34
• 38571 (bilateral total pelvic PLND) — wRVU 14.76
• 38572 (bilateral total pelvic PLND + para-aortic sampling) — wRVU approximately 16.94
• 38573 (bilateral total pelvic PLND + bilateral para-aortic PLND + omentectomy or peritoneal biopsies) — wRVU approximately 21.94

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Assistant Surgeon

CPT 38571 has an assistant surgeon indicator that allows payment under Medicare when medical necessity for a second surgical operator is documented. Given that 38571 is almost universally performed alongside major pelvic oncologic procedures (radical prostatectomy, cystectomy, radical hysterectomy), the concurrent primary procedure itself often justifies and necessitates an assistant surgeon.

• Modifier -80 — Assistant Surgeon. The assisting physician bills 38571-80 (and the primary procedure code with -80) at 16% of the primary surgeon’s allowed amount.
• Modifier -82 — Assistant Surgeon (qualified resident not available). Used at teaching institutions when no resident was available to assist.
• Modifier -62 — Co-Surgery. When two surgeons of equal standing each perform distinct portions of the procedure simultaneously (e.g., one performs the PLND while the other performs the cystectomy, with each contributing independently), both surgeons bill the applicable codes with Modifier 62. Each surgeon receives 62.5% of the allowed amount. This arrangement is particularly common in complex gynecologic oncology cases where a urologist and gynecologic oncologist co-operate.

Important distinction between Modifier 80 (assistant) and Modifier 62 (co-surgeon): In Modifier 80, one surgeon is clearly the primary operator and the second is an assistant who does not independently perform the procedure. In Modifier 62, both surgeons are performing distinct components of the same combined procedure, each taking primary responsibility for their portion. Documentation must reflect the nature of each surgeon’s independent contribution to support Modifier 62.

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HCC Relevance

CPT 38571 is a procedure code and does not itself carry HCC mapping. However, this procedure is performed almost exclusively in patients with active malignancy, and the associated diagnosis codes carry substantial HCC weight across all CMS risk-adjustment models.

High-Weight HCC Codes Commonly Associated with 38571 Encounters:

• C61 (Prostate Malignancy) → HCC 12 (Breast, Prostate, Colorectal and Other Cancers and Tumors). Moderate-weight HCC.
• C54.1 (Endometrial Malignancy) → HCC 11 (Colorectal, Bladder, and Other Cancers and Tumors) or HCC 10 (Lymphatic, Head and Neck, Brain, and Other Major Cancers) depending on staging and grade.
• C53.9 (Cervical Malignancy) → HCC 11 or HCC 10.
• C56.x (Ovarian Malignancy) → HCC 10. Ovarian cancer is classified in the higher-weight major cancer HCC category.
• C67.x (Bladder Malignancy) → HCC 11.
• C77.5 (Secondary Malignant Neoplasm of Intrapelvic Lymph Nodes) → HCC 8 (Metastatic Cancers and Acute Leukemia). This is among the highest-weight cancer HCC categories, reflecting metastatic disease.
• Z85.x (Personal History of Malignancy) → not HCC-mapped. Ensure active malignancy codes are captured rather than history codes when the cancer is still under active treatment.
• E43 (Unspecified Severe Protein-Calorie Malnutrition) → HCC 21. Malnutrition is common in oncology patients and should always be captured when documented, as it contributes both to HCC risk score and DRG CC/MCC weight.
• D64.9 (Anemia, unspecified) or D50.9 (Iron-deficiency anemia) — not HCC-mapped individually, but contribute to CC/MCC DRG weight.

Note

For risk-adjustment and value-based care purposes, comprehensive capture of all active malignancy codes, their staging when documented, and all treatment-related complications is essential. The HCC score of a cancer patient undergoing 38571 is among the highest in any surgical patient population.

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Code Tree / Related Procedure Codes

Understanding the full laparoscopic and open lymphadenectomy code family — and its interaction with concurrent gynecologic, urologic, and oncologic procedure codes — is essential for accurate code selection and appropriate bundling decisions.

Laparoscopic Lymph Node Procedures — CPT 38570-38589
│
├── RETROPERITONEAL SAMPLING
│   └── 38570 — Laparoscopy, surgical; with retroperitoneal lymph node sampling (biopsy)
│                Single or multiple nodes removed; sentinel nodes, suspicious nodes
│                wRVU ~9.34 | 10-day global
│                Use for: sentinel node excision, limited targeted biopsy, few isolated nodes
│
├── BILATERAL TOTAL PELVIC LYMPHADENECTOMY
│   └── 38571 — Laparoscopy, surgical; with bilateral total pelvic lymphadenectomy ← THIS CODE
│                Complete bilateral excision of pelvic node packets (ext iliac, int iliac, obturator)
│                wRVU 14.76 | 10-day global
│                Use Modifier 52 if only unilateral dissection completed
│
├── BILATERAL PELVIC + PARA-AORTIC SAMPLING
│   └── 38572 — Laparoscopy, surgical; with bilateral total pelvic lymphadenectomy
│                and peri-aortic lymph node sampling (biopsy), single or multiple
│                wRVU ~16.94 | 10-day global
│                Use when para-aortic nodes sampled IN ADDITION to complete bilateral PLND
│
├── BILATERAL PELVIC + BILATERAL PARA-AORTIC + OMENTECTOMY/PERITONEAL BIOPSIES
│   └── 38573 — Laparoscopy, surgical; with bilateral total pelvic lymphadenectomy,
│                bilateral peri-aortic lymph node sampling AND omentectomy or peritoneal biopsies
│                wRVU ~21.94 | 10-day global
│                Added 2018; captures comprehensive laparoscopic staging for gyn oncology
│
├── UNLISTED LAPAROSCOPIC LYMPH NODE PROCEDURE
│   └── 38589 — Unlisted laparoscopy procedure, lymphatic system
│                Use when no existing code accurately describes the procedure
│                Example: unilateral only pelvic PLND without using 38571-52
│
├── OPEN PELVIC LYMPHADENECTOMY (not laparoscopic — do NOT use 38571)
│   ├── 38770 — Pelvic lymphadenectomy including external iliac and obturator nodes
│   │            wRVU varies | 90-day global | Unilateral; use Modifier 50 for bilateral
│   └── 38780 — Retroperitoneal lymphadenectomy, extensive (pelvic, paraaortic, infrarenal)
│                wRVU varies | 90-day global
│
├── LIMITED LYMPHADENECTOMY FOR STAGING
│   ├── 38562 — Limited lymphadenectomy for staging; pelvic and para-aortic (open)
│   └── 38564 — Limited lymphadenectomy for staging; retroperitoneal (aortic and/or splenic) (open)
│
├── ADD-ON CODE — SENTINEL NODE MAPPING
│   └── 38900 — Intraoperative identification (eg, mapping) of sentinel lymph node(s), includes
│                injection of non-radioactive dye, when performed (add-on code)
│                Approved for use with 38571 as of 2019 update
│                Bill 38900 once (or with Modifier 50 for bilateral mapping) alongside 38571
│
└── COMMONLY COMBINED PRIMARY PROCEDURE CODES
├── 55866 — Laparoscopy, surgical prostatectomy, retropubic radical (robotic-assisted)
│            PLND + 55866 is the standard robotic prostatectomy with staging combination
├── 51575 — Cystectomy, complete; with bilateral pelvic lymphadenectomy
│            NOTE: PLND is INCLUDED in 51575 — do NOT separately report 38571
├── 51590 — Cystectomy, complete, with ureteroileal conduit or sigmoid bladder,
│            including intestine anastomosis; with bilateral pelvic lymphadenectomy
│            NOTE: PLND is INCLUDED — do NOT separately report 38571
├── 51595 — Cystectomy, complete; with continent diversion, with bilateral pelvic PLND
│            NOTE: PLND is INCLUDED — do NOT separately report 38571
├── 58548 — Laparoscopy, surgical, with radical hysterectomy, with bilateral total PLND
│            and peri-aortic lymph node sampling (PLND INCLUDED — do not add 38571)
├── 58571 — Laparoscopy, surgical, with total hysterectomy for uterus 250g or less;
│            with removal of tubes and/or ovary(s)
│            NOTE: 38571 IS separately reportable with 58571 — they cover different procedures
├── 58573 — Laparoscopy, surgical, with total hysterectomy for uterus greater than 250g;
│            with removal of tubes and/or ovary(s)
│            NOTE: 38571 IS separately reportable with 58573
├── 58210 — Radical abdominal hysterectomy with bilateral total PLND and PA sampling
│            NOTE: PLND is INCLUDED in 58210 — do NOT separately report 38571
└── 58954 — Bilateral salpingo-oophorectomy with omentectomy, TAH and radical dissection
NOTE: Review carefully — PLND may or may not be included depending on extent coded

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Includes / What This Code Covers

• Laparoscopic or robotic-assisted laparoscopic surgical removal of the bilateral pelvic lymph node packets, including the external iliac, internal iliac (hypogastric), and obturator node groups on both sides
• Any degree of completeness of the bilateral pelvic dissection — whether the surgeon removes 5 nodes or 35 nodes bilaterally — as long as the intent was a total therapeutic pelvic lymphadenectomy and the documentation reflects bilateral dissection
• Procedures performed with any laparoscopic energy platform or technique (scissors, monopolar, bipolar, advanced energy devices, clip appliers, ultrasonic dissectors)
• The operative approach work — port placement, pneumoperitoneum establishment, peritoneal entry, retroperitoneal exposure — as these are inherent to the laparoscopic approach
• Removal of lymph nodes from the common iliac region up to but not reaching the para-aortic level. Common iliac node dissection, when performed as part of the pelvic PLND, is captured within 38571 and does not automatically trigger 38572
• Intraoperative frozen section evaluation of sampled nodes, when the node removal is captured by 38571 (the pathology processing is a separate charge from the laboratory)
• Post-operative care within the 10-day global period by the performing surgeon for operative-site related issues
• Application of hemostatic clips and ligation of lymphatic channels as necessary to prevent lymphocele formation — included in 38571

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Excludes / What This Code Does NOT Cover

• Open pelvic lymphadenectomy — 38571 is strictly a laparoscopic code. Open bilateral pelvic lymphadenectomy is reported with 38770 (with Modifier 50 for bilateral) or, when bundled into an open cystectomy/hysterectomy, within those parent codes.
• Para-aortic lymph node sampling or dissection — once the dissection extends above the pelvic brim to include aortic or vena caval nodes, the procedure should be reported with 38572 (with PA sampling) or 38573 (with bilateral PA PLND and omentectomy), not 38571.
• Sentinel node biopsy only — selective removal of sentinel nodes or a few targeted suspicious nodes is reported with 38570, not 38571. The distinction is completeness of the bilateral regional node packet dissection.
• PLND when already included in the bundled concurrent procedure code — several CPT codes for cystectomy (51575, 51590, 51595) and radical hysterectomy (58210, 58548) include bilateral pelvic lymphadenectomy in their descriptor and therefore in their work value. Reporting 38571 separately in addition to these codes constitutes unbundling and is a compliance violation.
• Modifier 50 appended to 38571 — bilaterality is inherent in the code descriptor. Adding Modifier -50 implies a unilateral procedure was performed twice, which misrepresents the service and may result in double reimbursement. Use Modifier -52 if only one side was completed.
• Retroperitoneal lymph node dissection (RPLND) for testicular cancer — classical RPLND for testicular cancer is reported with separate retroperitoneal lymphadenectomy codes (38780 for open; 38571 does NOT capture the retroperitoneal dissection above the pelvic brim and below the renal vessels that characterizes testicular cancer RPLND).
• Post-operative lymphocele drainage — if a lymphocele develops and requires drainage (aspiration, percutaneous drainage, or surgical marsupialization), this is a separate procedure reportable with the applicable drainage or laparoscopic procedure code and Modifier 78 (if during the global period) or 79 (if unrelated during global period of another procedure).
• E/M visits within the 10-day global period by the same operating surgeon for procedure-related issues — these are included in the 38571 global payment and should not be separately billed.

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NCCI Edits and Bundling Considerations

• 38571 with 38570 (retroperitoneal sampling): These codes are mutually exclusive for the same anatomic territory in the same session. If a total bilateral pelvic PLND was performed (38571), sentinel node mapping and sampling are considered included — do not add 38570 for sampling of the same pelvic node territory.
• 38571 with 38572 or 38573: These codes represent progressively more extensive versions of the same procedure. Only one code from this family (38571, 38572, 38573) should be reported per operative session — choose the code that most accurately reflects the full extent of the procedure performed.
• 38571 with cystectomy codes (51575, 51590, 51595, 51596): These cystectomy CPT codes explicitly include bilateral pelvic lymphadenectomy in their descriptors. The AMA CPT manual considers the PLND inherently included in these codes. Reporting 38571 separately with any of these cystectomy codes is an unbundling violation. This is among the most frequently audited pairing in urology coding compliance.
• 38571 with 58210 (radical abdominal hysterectomy with bilateral PLND and PA sampling): 58210 includes the bilateral pelvic lymphadenectomy. 38571 cannot be separately billed with 58210.
• 38571 with 58548 (laparoscopic radical hysterectomy with bilateral PLND and PA sampling): Same rule — PLND is included in 58548.
• 38571 with 55866 (robotic laparoscopic radical prostatectomy): 55866 does NOT include the pelvic lymphadenectomy — they are separate procedures with separate work values. 38571 IS separately reportable with 55866. This is one of the most common correctly paired code combinations in urology and should not be suppressed.
• 38571 with laparoscopic hysterectomy codes (58570-58573): These laparoscopic hysterectomy codes do NOT include the bilateral pelvic lymphadenectomy. The PLND is separately reportable. 38571 should be reported in addition to 58570, 58571, 58572, or 58573 with Modifier 51 applied to the lesser-value code.
• 38900 (sentinel node mapping) with 38571: 38900 is an add-on code explicitly listed as compatible with 38571 since the 2019 CPT update. When sentinel node mapping with non-radioactive dye (e.g., indocyanine green/ICG) is performed in addition to the complete bilateral pelvic PLND, 38900 may be separately billed. Use Modifier 50 on 38900 for bilateral mapping, or -RT/-LT as appropriate depending on laterality of mapping.
• 38571 with 51999 (unlisted laparoscopic cystectomy): When billing an unlisted cystectomy code (51999) benchmarked to an open cystectomy code that includes PLND (such as 51590), the PLND may already be reflected in the benchmarked value. Coders must ensure the PLND is not being captured twice — once within the benchmarked value and once via separate 38571 billing.

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Modifiers

• -52 (Reduced Services) — The most important modifier specific to 38571. Required when the bilateral dissection was not completed — i.e., only one side was dissected, the procedure was interrupted before completion, or the planned bilateral dissection could not be performed due to anatomic factors or intraoperative complications. Without Modifier 52, reporting 38571 for a unilateral dissection is overcoding. The reduction in payment is typically negotiated at the payer level but often approximates 50% of the full bilateral fee.
• -51 (Multiple Procedures) — Applied to 38571 when it is reported as a secondary procedure alongside a higher-value primary procedure (e.g., 55866 as primary, 38571 as secondary). The multiple procedure reduction rule reduces the secondary procedure’s payment by 50% under Medicare. 38571 often takes the Modifier 51 position in complex combined procedures.
• -62 (Co-Surgery) — Applied when two surgeons of equal standing each independently perform distinct components of the total procedure. Each surgeon bills the applicable codes with Modifier 62 at 62.5% of the allowed amount. Common in complex gyn-onc cases involving a gynecologic oncologist and a urologist co-operating.
• -80 (Assistant Surgeon) — The assistant surgeon applies Modifier 80 to all procedure codes for which assistance was provided.
• -78 (Unplanned Return to OR for Related Procedure) — Applied when a return to the OR within the 10-day global period is required for a complication related to the original 38571 (e.g., surgical exploration for lymphocele causing acute obstruction).
• -79 (Unrelated Procedure During Postoperative Period) — Applied when an unrelated procedure is performed during the 10-day global period.
• -58 (Staged Procedure) — Applied when 38571 is performed as a planned staged component of a multi-step treatment plan during another procedure’s global period.
• -59 or -XS (Distinct Procedural Service / Separate Structure) — Applied to 38571 when payer edits bundle it with a concurrent procedure code that does not actually include the PLND in its work value (e.g., if an edit incorrectly bundles 38571 with 55866). Modifier 59 or XS combined with appropriate documentation supports separate billing.

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Documentation Requirements

For accurate assignment of 38571 and defense of all concurrent code combinations, the operative note must clearly document:

1. Approach — explicit confirmation of laparoscopic or robotic-assisted laparoscopic approach. A note that states only “pelvic lymphadenectomy performed” without specifying approach is ambiguous — document “laparoscopic bilateral pelvic lymphadenectomy” or “robotic-assisted bilateral pelvic lymph node dissection.”
2. Bilateral performance — the note must document dissection on BOTH sides. If only one side was completed, the note must explain why and describe what was accomplished on the incomplete side — this documentation supports Modifier 52.
3. Node groups dissected — while CPT 38571 does not require enumeration of specific node groups, documentation of the specific anatomic regions dissected (e.g., “external iliac, internal iliac, and obturator regions bilaterally”) strengthens the medical necessity argument and confirms the procedure is a total PLND rather than a limited sampling.
4. Node count or specimen description — pathology will report the total node count, but the surgeon should document that specimens were sent and from which sides. Many payers and quality programs now require a minimum lymph node count for adequacy of staging.
5. Relationship to primary procedure — when performed concurrently with prostatectomy, cystectomy, or hysterectomy, the note should clearly delineate the separate components of the combined procedure, establishing that both the primary procedure and the PLND were performed as distinct operative steps.
6. Indication — the clinical reason for the lymphadenectomy must be documented. For staging, documentation such as “bilateral pelvic lymphadenectomy performed for surgical staging of endometrial carcinoma” is ideal. For therapeutic intent in known nodal disease, “therapeutic bilateral pelvic lymphadenectomy for biopsy-confirmed pelvic nodal metastases from prostate cancer” provides the clearest support.
7. Sentinel node mapping details — if 38900 is being reported, the note must document injection of the mapping agent (ICG, isosulfan blue, methylene blue), identification of the sentinel node(s), and excision of the identified sentinel node(s). This documentation is required to support the add-on code.

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Coding Examples

Example 1 — Robotic Radical Prostatectomy with Bilateral Pelvic Lymphadenectomy (Urology) A patient with intermediate-risk prostate cancer (Gleason 3+4=7, PSA 8.2, stage T2b) undergoes robotic-assisted laparoscopic radical prostatectomy with bilateral pelvic lymph node dissection. The surgeon performs nerve-sparing prostatectomy followed by bilateral dissection of the external iliac, internal iliac, and obturator node packets. Twenty-two lymph nodes are submitted to pathology (11 right, 11 left). All nodes negative.

Physician CPT Codes: 55866 (robotic radical prostatectomy), 38571-51 (bilateral total pelvic lymphadenectomy, multiple procedure) Diagnosis: C61 (Malignant neoplasm of prostate) Note: 38571 IS separately reportable with 55866. This is one of the most common correctly paired urology code combinations. Modifier 51 is applied to 38571 as the lesser-value secondary procedure. ICD-10-PCS (inpatient): 0VT00ZZ (Resection of Prostate, Open Approach or 0VT04ZZ for robotic/laparoscopic), 07BC4ZZ (Excision of Pelvis Lymphatic, Percutaneous Endoscopic)

Example 2 — Laparoscopic Hysterectomy with Bilateral Pelvic PLND for Endometrial Cancer (GYN-Onc) A patient with grade 2 endometrioid endometrial carcinoma undergoes laparoscopic total hysterectomy, bilateral salpingo-oophorectomy, and bilateral total pelvic lymphadenectomy. Uterine weight is 180 grams. Sentinel node mapping with ICG is performed bilaterally prior to the PLND.

Physician CPT Codes: 58571 (laparoscopic total hysterectomy with BSO, uterus 250g or less), 38571-51 (bilateral total pelvic lymphadenectomy), 38900-50 (sentinel node mapping, bilateral) Diagnosis: C54.1 (Malignant neoplasm of endometrium) Note: 38571 is separately reportable with 58571 — the hysterectomy code does NOT include the PLND. The sentinel node mapping add-on (38900) is billed with Modifier 50 for bilateral mapping and is appropriately reported alongside 38571.

Example 3 — Incomplete Unilateral PLND Due to Intraoperative Hemorrhage A patient with bladder cancer undergoes laparoscopic radical cystectomy. During the bilateral pelvic PLND, significant venous bleeding from the right external iliac vein is encountered on the left side during the left node dissection. The right-sided dissection is completed in full. The left-sided dissection is abandoned after partial completion due to the hemorrhage.

Physician CPT Code: 38571-52 (bilateral total pelvic lymphadenectomy, reduced services — only right side completed to full dissection) Note: The cystectomy in this scenario involves unlisted code or open cystectomy code consideration separately. The 38571-52 reflects that the full bilateral dissection was not completed. The operative note must document what was accomplished on the left side and why the dissection was terminated.

Example 4 — Bilateral Pelvic PLND with Para-Aortic Node Sampling (Wrong Code Selection Scenario) A patient with advanced cervical cancer (stage IB2) undergoes laparoscopic bilateral total pelvic lymphadenectomy. After completing the bilateral pelvic node dissection, the surgeon continues proximally and removes three para-aortic lymph nodes bilaterally (two right, one left) just below the inferior mesenteric artery.

Correct Code: 38572 (laparoscopic bilateral total pelvic lymphadenectomy with peri-aortic lymph node sampling) — NOT 38571 Rationale: The addition of para-aortic node sampling elevates the procedure to 38572. The descriptor for 38571 does not include para-aortic dissection. Reporting 38571 in this scenario is undercoding, as the more extensive procedure was actually performed. A wRVU differential of approximately 2.18 wRVU separates 38571 from 38572. Diagnosis: C53.9 (Malignant neoplasm of cervix uteri, unspecified)

Example 5 — Radical Cystectomy with Pelvic PLND — Incorrect Unbundling Scenario A patient with T2 urothelial carcinoma of the bladder undergoes open radical cystectomy with bilateral pelvic lymphadenectomy (CPT 51575) and ileal conduit urinary diversion.

Incorrect Coding: 51575 + 38571 (WRONG — unbundling violation) Correct Coding: 51575 only. CPT 51575 explicitly includes bilateral pelvic lymphadenectomy including external iliac, hypogastric, and obturator nodes in its descriptor. Reporting 38571 in addition to 51575 is a prohibited unbundle and is specifically addressed in NCCI edits. This is one of the most audited urology coding pairings.

Example 6 — Inpatient Coder Scenario — PCS Code Selection The same patient as Example 1 is admitted inpatient. The robotic radical prostatectomy with bilateral pelvic PLND is performed on hospital day 1.

ICD-10-PCS Codes:

• 0VT04ZZ — Resection of Prostate, Percutaneous Endoscopic Approach (robotic prostatectomy)
• 07BC4ZZ — Excision of Pelvis Lymphatic, Percutaneous Endoscopic Approach (bilateral pelvic PLND) Principal Diagnosis: C61 (Malignant neoplasm of prostate) DRG: MS-DRG 756, 757, or 758 depending on CC/MCC presence PCS Note: 07BC4ZZ (not 07TC4ZZ) is the correct code because even a “total” bilateral pelvic lymphadenectomy does not remove the entire pelvis lymphatic body part as defined in PCS — use Excision (B), not Resection (T).

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Coding Pitfalls and Common Errors

• Appending Modifier 50 to 38571: Bilateral is inherent in the code. Adding Modifier 50 implies a unilateral procedure was performed twice, potentially resulting in double reimbursement and triggering a compliance audit. Never use Modifier 50 with 38571.
• Reporting 38571 with cystectomy codes that include PLND in their descriptors (51575, 51590, 51595, 51596): This is unbundling. These cystectomy codes include the PLND in their work value. Separately billing 38571 with any of these codes is a compliance violation and will appear on standard NCCI edit reports.
• Reporting 38571 with 58210 or 58548 (radical hysterectomy codes that include PLND): Same principle — those codes already bundle the PLND. Review the descriptor of every concurrent hysterectomy code before billing 38571 separately.
• Using 38571 instead of 38570 for sentinel node biopsy: Sentinel node procedures involve targeted removal of mapped nodes — a sampling, not a total lymphadenectomy. 38570 is the correct code for sentinel node procedures, paired with 38900 for the mapping. Using 38571 for sentinel node work overcodes the procedure.
• Failing to report 38571 separately with 55866 (robotic prostatectomy) or 58571/58573 (laparoscopic hysterectomy codes): The reverse error is also common. These codes do NOT include the PLND, and failure to separately report 38571 when a full bilateral PLND was performed results in significant undercoding and revenue loss.
• Using 38571 for open pelvic lymphadenectomy: 38571 is a laparoscopic code. An open bilateral pelvic lymphadenectomy is reported with 38770 (with Modifier 50 for bilateral). Applying the laparoscopic code to an open procedure is a misrepresentation of the service rendered.
• PCS — using Resection (T) instead of Excision (B) for bilateral pelvic PLND: In ICD-10-PCS, even a complete bilateral pelvic lymphadenectomy typically uses the Excision root operation (07BC4ZZ), not Resection (07TC4ZZ). Resection requires removal of the entire body part, which is almost never the case in pelvic PLND practice.
• PCS — failing to use Percutaneous Endoscopic approach (character 4) for robotic PLND: Robotic and laparoscopic approaches are both coded as Percutaneous Endoscopic (4) in PCS. Using Open (0) for a robotic PLND is incorrect and misrepresents the minimally invasive nature of the procedure.
• Not capturing 38900 when sentinel node mapping was performed: 38900 is a separately billable add-on code when ICG or other non-radioactive dye mapping is performed prior to or during the PLND. Failing to report 38900 when mapping was clearly documented leaves legitimate revenue on the table.