38572

🧬CPT 38572: Laparoscopic Pelvic Lymphadenectomy & Peri-aortic Sampling

Detailed Description

CPT code 38572 describes a minimally invasive surgical procedure performed using a laparoscope to remove all the lymph nodes from both the left and right sides of the pelvis. This is referred to as a bilateral total pelvic lymphadenectomy. The goal is to remove the lymph node groups that are the primary drainage sites for pelvic organs, such as the prostate, bladder, uterus, cervix, and ovaries.

This procedure is most commonly performed for the staging and/or treatment of cancers originating in the pelvis. By removing and analyzing these lymph nodes, pathologists can determine if the cancer has spread (metastasized), which is crucial for determining the patient’s prognosis and guiding further treatment, such as radiation or chemotherapy. The surgeon makes several small incisions in the abdomen, inflates the abdominal cavity with carbon dioxide gas (pneumoperitoneum) to create space, and then uses a camera (laparoscope) and specialized long-handled instruments to dissect and remove the targeted lymph node packets.

Key Anatomical Structures

The dissection typically includes the removal of lymph nodes along the following major blood vessels in the pelvis:

• External iliac artery and vein
• Internal iliac (hypogastric) artery and vein
• Obturator fossa nodes

Code Details

• Official Description: Laparoscopy, surgical; with bilateral total pelvic lymphadenectomy and peri-aortic lymph node sampling, single or multiple.
• Plain Language Description: The surgeon uses a laparoscope (a thin, lighted tube) to perform a complete removal of all lymph nodes from both sides of the pelvis (bilateral total pelvic lymphadenectomy). In the same procedure, the surgeon also takes samples (biopsies) of the lymph nodes along the aorta in the abdomen (peri-aortic) to check for the spread of disease, typically cancer.
• wRVU: 20.30
• Assistant Payable: Yes. The CMS Physician Fee Schedule indicator is ‘2’, meaning an assistant surgeon may be paid if medical necessity is documented. Documentation should clearly state the complexity of the case or specific patient factors that required an assistant.
• Global Period: 90 days

Code Context & Guidelines

Includes

This code is a comprehensive package for laparoscopic lymph node staging and includes the following components, which are not separately billable:

• All aspects of the laparoscopic approach (e.g., establishing pneumoperitoneum, trocar placement).
• A diagnostic laparoscopy performed immediately prior to the surgical procedure.
• Lysis of minor adhesions required to access the operative field.
• Dissection and removal of all identifiable pelvic lymph node tissue from the external iliac, internal iliac (hypogastric), and obturator regions, bilaterally.
• Biopsy/sampling of one or more lymph nodes from the peri-aortic region.
• Control of minor bleeding.
• Irrigation of the surgical field.
• Standard surgical closure of trocar sites.

Excludes

This code describes a specific combination of procedures. Do not use 38572 if only one of the components is performed.

• For a bilateral pelvic lymphadenectomy without peri-aortic sampling, see 38571.
• For peri-aortic lymph node sampling without a complete pelvic lymphadenectomy, see 38573.
• If this procedure is performed in conjunction with a more extensive primary procedure (e.g., radical hysterectomy), specific CPT coding rules apply. For example, a radical hysterectomy 58572 includes the pelvic lymphadenectomy. In such cases, 38572 would not be separately reported. Always check NCCI edits.

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Associated Information

MS-DRG

This CPT code can map to several MS-DRGs, depending on the principal diagnosis and the presence of complications or comorbidities (CC/MCC). Common examples include:

• MS-DRG 736: Uterine & Adnexa Procedures for Ovarian or Adnexal Malignancy with MCC
• MS-DRG 737: Uterine & Adnexa Procedures for Ovarian or Adnexal Malignancy with CC
• MS-DRG 738: Uterine & 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

Common Supporting ICD-10-CM Diagnoses

Medical necessity for 38572 is established by a diagnosis that requires surgical staging. These are almost always malignant neoplasms.

ICD-10 Code	Description	HCC v28 Category
C53.9	Malignant neoplasm of cervix uteri, unspecified	20
C54.1	Malignant neoplasm of endometrium	20
C56.1	Malignant neoplasm of right ovary	20
C61	Malignant neoplasm of prostate	19
C67.7	Malignant neoplasm of urachus (bladder)	20

Note on HCC: Hierarchical Condition Category (HCC) coding applies to the diagnosis (ICD-10) codes, not the procedure (CPT) codes. The HCC category reflects the risk adjustment value of the patient’s chronic conditions. The malignant diagnoses listed above are significant, high-risk conditions that map to HCCs.

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CPT Code Tree

This helps visualize where 38572 fits within the CPT manual’s structure.

• Surgery (10021-69990)
  • Hemic and Lymphatic Systems (38100-38999)
    • Lymph Nodes and Lymphatic Channels (38500-38794)
      • Laparoscopy (38570-38573)
        • 38570: Laparoscopy, surgical; with retroperitoneal lymph node sampling (biopsy), single or multiple
        • 38571: Laparoscopy, surgical; with bilateral total pelvic lymphadenectomy
        • 38572: Laparoscopy, surgical; with bilateral total pelvic lymphadenectomy and peri-aortic lymph node sampling, single or multiple
        • 38573: Laparoscopy, surgical; with para-aortic lymph node sampling (biopsy), single or multiple

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Coding Examples & Scenarios

Scenario 1: Staging for Endometrial Cancer

Patient: A 62-year-old female with a recent endometrial biopsy confirming Grade 2 endometrioid adenocarcinoma. Pre-operative imaging is inconclusive regarding lymph node involvement. The plan is for surgical staging prior to determining the need for adjuvant therapy.

Procedure Performed: The surgeon performs a laparoscopic exploration. The uterus appears enlarged but there is no obvious extrauterine disease. A complete bilateral pelvic lymphadenectomy is performed, clearing the obturator and iliac nodal packets. Following this, the surgeon proceeds to the upper abdomen and samples several suspicious-feeling lymph nodes from the infrarenal para-aortic region. The specimens are sent to pathology separately labeled.

• CPT Code: 38572
• ICD-10-CM Code: C54.1 - Malignant neoplasm of endometrium

Rationale: The procedure documented includes both key components of code 38572: a bilateral total pelvic lymphadenectomy AND peri-aortic lymph node sampling. This was performed as a standalone staging procedure.

Scenario 2: Staging for Locally Advanced Prostate Cancer

Patient: A 68-year-old male with high-risk, clinically localized prostate cancer (C61). His PSA is elevated and biopsy revealed a high Gleason score. An MRI suggests possible involvement of pelvic lymph nodes. He is scheduled for an extended pelvic lymph node dissection to guide treatment decisions between radical prostatectomy and radiation therapy.

Procedure Performed: A laparoscopic extended pelvic lymphadenectomy is performed, which includes removal of the standard external iliac, obturator, and internal iliac nodes. The dissection is carried superiorly to the aortic bifurcation, and multiple lymph nodes are sampled from the common iliac and para-aortic regions up to the level of the inferior mesenteric artery.

• CPT Code: 38572
• ICD-10-CM Code: C61 - Malignant neoplasm of prostate

Rationale: Even though it’s often called an “extended” pelvic lymphadenectomy in urology, the procedure as described fits the CPT definition of a bilateral pelvic lymphadenectomy plus sampling of the peri-aortic nodes. CPT 38572 accurately captures the work performed.

Example 1: Staging for Uterine Cancer

• Patient: A 62-year-old female diagnosed with high-grade endometrial cancer.
• Procedure: The patient undergoes a robotic-assisted total laparoscopic hysterectomy, bilateral salpingo-oophorectomy, and a staging bilateral total pelvic lymphadenectomy. The surgeon removes the uterus, cervix, fallopian tubes, ovaries, and all associated pelvic lymph node packets.
• CPT Codes:
  • 58571: Laparoscopy, surgical, with total hysterectomy, for uterus 250 g or less
  • 38572: Laparoscopy, surgical; with bilateral total pelvic lymphadenectomy
• ICD-10-CM Diagnosis Code:
  • C54.1: Malignant neoplasm of endometrium
• HCC Information: The diagnosis code C54.1 maps to HCC 12: Metastatic Cancer and Acute Leukemia, which reflects a higher disease burden for risk adjustment calculations.

Example 2: Staging for High-Risk Prostate Cancer

• Patient: A 68-year-old male with a high Gleason score prostate cancer, scheduled for a radical prostatectomy.
• Procedure: The surgeon performs a robotic-assisted radical prostatectomy and an extensive bilateral pelvic lymphadenectomy to check for metastatic disease.
• CPT Codes:
  • 55866: Laparoscopy, surgical prostatectomy, retropubic radical, including nerve sparing, includes robotic assistance, when performed.
  • 38572: Laparoscopy, surgical; with bilateral total pelvic lymphadenectomy.
  • Note: Payer policies and NCCI edits must be checked. While often performed together, some payers may consider the lymphadenectomy bundled into the radical prostatectomy code. If the dissection is significantly more extensive than is typically included, it may be separately reportable.
• ICD-10-CM Diagnosis Code:
  • C61: Malignant neoplasm of prostate
• HCC Information: The diagnosis code C61 maps to HCC 11: Prostate Cancer, used in risk adjustment models.