Crystal's MCW Coder Hub🧬CPT Code 38760: Inguinofemoral Lymphadenectomy, Superficial
Description
CPT 38760 represents a surgical procedure to remove the superficial lymph nodes in the groin (inguinal) and upper thigh (femoral) region. This is also known as a superficial groin dissection. The procedure is explicitly defined as including the removal of Cloquet’s node, which is the highest deep inguinal node located in the femoral canal. This node is considered the gateway between the superficial and deep inguinal lymph node systems.
The procedure involves a skin incision in the groin area over the femoral triangle. The surgeon dissects through the subcutaneous tissue to remove the packet of superficial inguinal lymph nodes. A critical component explicitly included in this code is the removal of Cloquet’s node, which is the highest deep inguinal node located in the femoral canal, serving as a gateway between the superficial and deep lymphatic systems of the groin.
The primary goal is therapeutic (removing cancerous nodes) or, in some cases, diagnostic/staging (determining the extent of cancer spread). The femoral vessels (artery and vein) are identified and carefully preserved during the dissection.
CPT Code Details
- Official Descriptor: Inguinofemoral lymphadenectomy, superficial, including Cloquet’s node (superficial groin dissection).
- Layman’s Description: The surgeon makes an incision in the groin area and carefully removes the top layer of lymph nodes from the groin and upper thigh. This helps determine if cancer has spread from a nearby site or to remove cancerous nodes.
- wRVU: 10.04 (Work Relative Value Units - subject to change by CMS annually)
- Assistant Surgeon Payable: Yes. The “ASST SURG” indicator is “2,” meaning an assistant surgeon is payable with appropriate documentation of medical necessity.
- MS-DRG (Representative): This procedure is typically performed inpatient. The MS-DRG is determined by the principal diagnosis. Common DRGs include:
- MS-DRG 584: Skin Grafts & Musculoskeletal Procedures w MCC
- MS-DRG 746: Malignancy, Male Reproductive System w MCC
- MS-DRG 757: Malignancy, Female Reproductive System w CC
Includes & Excludes
Includes
This code is considered a “package” that includes the following components:
- Incision in the groin region.
- Identification and dissection of the Camper’s and Scarpa’s fascia.
- Mobilization and removal of all superficial inguinal and femoral lymph node-bearing tissue.
- Identification and removal of Cloquet’s node.
- Ligation of lymphatic channels and small blood vessels.
- Placement of a surgical drain (if performed).
- Standard wound closure.
Excludes
Do not report 38760 with the following. Use separate codes when appropriate:
- Deep Inguinal/Femoral Lymphadenectomy: If the surgeon also removes the deep femoral nodes (those deep to the fascia lata), you must use CPT 38765 (Inguinofemoral lymphadenectomy, complete, including Cloquet’s node [deep groin dissection]). You would not report 38760 and 38765 together for the same side.
- Pelvic Lymphadenectomy: Removal of pelvic lymph nodes (iliac, obturator) is a separate procedure and should be coded separately (e.g., 38770).
- Sentinel Node Biopsy: If only a sentinel node is biopsied, use 38531 (Biopsy or excision of lymph node(s); open, deep inguinal region).
- Primary Tumor Excision: The excision of the primary cancer (e.g., radical vulvectomy 56630, wide excision of melanoma) is coded separately.
Code Tree (CPT Hierarchy)
Commonly Associated ICD-10-CM Codes
This procedure is performed for a confirmed or suspected malignancy. The ICD-10 code should reflect the primary cancer site and, if confirmed, the metastasis to the lymph nodes.
| Code | Description | HCC Category (Example) |
|---|---|---|
| C43.71 | Malignant melanoma of right lower limb, including hip | HCC 12: Breast, Prostate, & Other Cancers and Tumors |
| C44.722 | Squamous cell carcinoma of skin of left lower limb, including hip | HCC 12: Breast, Prostate, & Other Cancers and Tumors |
| C51.9 | Malignant neoplasm of vulva, unspecified | HCC 12: Breast, Prostate, & Other Cancers and Tumors |
| C60.9 | Malignant neoplasm of penis, unspecified | HCC 12: Breast, Prostate, & Other Cancers and Tumors |
| C21.1 | Malignant neoplasm of anal canal | HCC 10: Cancer of Colon, Rectum, & Anus |
| C77.4 | Secondary and unspecified malignant neoplasm of inguinal and lower limb lymph nodes | HCC 8: Metastatic Cancer and Acute Leukemia |
Note on HCC (Hierarchical Condition Category):
HCC codes are used by Medicare Advantage plans to risk-adjust patient payments. A diagnosis with an HCC value indicates a higher-risk, more complex patient, which can affect reimbursement. Malignancies and metastases are high-value HCCs.
Coding Examples
Example 1: Melanoma Staging
- Scenario: A 55-year-old male with a malignant melanoma on his left calf underwent a sentinel lymph node biopsy which came back positive for metastasis. He is now scheduled for a therapeutic left superficial groin dissection. The surgeon performs a left inguinofemoral lymphadenectomy, removing the superficial chain of nodes and Cloquet’s node.
- CPT Code: 38760-LT
- ICD-10-CM Codes:
Example 2: Vulvar Cancer
- Scenario: A 68-year-old female is diagnosed with Stage IB squamous cell carcinoma of the vulva. The treatment plan involves a radical partial vulvectomy and a unilateral right superficial inguinofemoral lymphadenectomy for staging purposes. The procedures are performed during the same operative session.
- CPT Codes:
- 56630 - Radical partial vulvectomy
- 38760-59-RT (Modifier 59 is used to indicate a distinct procedural service from the vulvectomy, performed on a separate anatomical region through a separate incision)
- ICD-10-CM Code:
- C51.9 - Malignant neoplasm of vulva, unspecified