38770

🧬 CPT 38770 - Pelvic Lymphadenectomy (Complete)

Full Descriptor: Pelvic lymphadenectomy, including external iliac, hypogastric, and obturator nodes (unilateral)

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🧭 At a Glance

Field	Detail
CPT Code	38770
Code Family	Surgery / Hemic & Lymphatic Systems
Section	38700-38999 (Lymph Nodes and Lymphatic Channels)
Laterality	Unilateral (bilateral requires modifier -50 or two line items)
wRVU	~10.32 (verify against current CMS Physician Fee Schedule)
Assistant Payable	✅ Yes — assistant surgeon is payable under Medicare
Co-Surgery	✅ Eligible
Team Surgery	❌ Not typically reported as team surgery
Global Period	090 days
Facility vs. Non-Facility	Facility only (OR-level procedure)
Anesthesia	General or regional

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📖 Detailed Description

CPT 38770 describes the complete surgical removal of pelvic lymph nodes in a unilateral dissection encompassing three nodal basins:

1. External Iliac Nodes — Located along the external iliac vessels; drain the lower extremities, bladder, prostate/cervix/uterus, and perineum.
2. Hypogastric (Internal Iliac) Nodes — Located medially along the internal iliac vessels; drain the pelvic viscera including rectum, bladder, prostate, vagina, and uterus.
3. Obturator Nodes — Located in the obturator fossa, bordered by the obturator nerve, vessels, and the pelvic sidewall; a critical staging zone in prostate, bladder, and cervical malignancies.

This procedure is performed as:

• A standalone staging lymphadenectomy (particularly in prostate, bladder, penile, cervical, or uterine cancer)
• Concurrent with radical resection (e.g., radical prostatectomy, radical cystectomy, radical hysterectomy)
• A therapeutic lymphadenectomy when gross nodal disease is identified

The approach may be open (laparotomy), laparoscopic, or robotic-assisted. Note that robotic or laparoscopic performance does not change the CPT code — the approach modifier (e.g., -52 is not appropriate; robotic is not separately reported with a different CPT for this procedure, though facility charges for robotic systems may apply).

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✅ Includes

• Mobilization and skeletonization of the external iliac artery and vein
• Clearance of the obturator fossa including the obturator nerve identification and preservation (when feasible)
• Dissection along the internal iliac (hypogastric) vessels
• En bloc removal of fibrofatty nodal tissue
• Hemostasis and wound closure (as part of the overall operative case)
• Specimen submission for pathological evaluation

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❌ Excludes / Parenthetical Notes

Excluded Service	Code	Notes
Inguinofemoral lymphadenectomy (superficial only)	38760	If performed as a separate distinct dissection, may be separately reported
Inguinofemoral + pelvic lymphadenectomy (combined, in continuity)	38765	Describes a more extensive combined inguinal + pelvic dissection — do NOT report with 38770
Retroperitoneal lymphadenectomy (aortic, renal nodes)	38780	Separate, more extensive procedure
Sentinel lymph node biopsy	38792, 38900	Distinct technique; not bundled into 38770 if separately performed
Lymph node biopsy only	38500-38530	Open biopsy, not dissection
Laparoscopic surgical lymphadenectomy	38571, 38572	These are laparoscopic-specific codes — do not report 38770 for a laparoscopic approach unless payer policy directs otherwise; verify payer-specific guidance
Radical prostatectomy (if performed together)	55840, 55842, 55845	The pelvic lymphadenectomy is bundled into 55840/55845 per NCCI edits when performed at the same session — see bundling discussion below
Radical cystectomy	51570-51596	Lymphadenectomy may be bundled depending on code choice and payer

⚠️ NCCI Bundling Alert: When 38770 is reported with radical prostatectomy codes 55840 or 55845, it is frequently bundled (column 2 code) and not separately payable without a valid modifier and documentation supporting a distinct service. Always check current NCCI edits prior to billing.

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🔗 Code Tree — Lymphadenectomy Family (38700-38780)

Surgery → Hemic & Lymphatic Systems → Lymph Nodes
│
├── 38700 — Suprahyoid lymphadenectomy
├── 38720 — Cervical lymphadenectomy (radical), including postauricular, suboccipital,
│               sternocleidomastoid, submandibular, sublingual, jugular chain, and deltopectoral
├── 38724 — Cervical lymphadenectomy (modified radical)
├── 38740 — Axillary lymphadenectomy; superficial
├── 38745 — Axillary lymphadenectomy; complete
│
├── 🔵 INGUINOFEMORAL/PELVIC AXIS
│   ├── 38760 — Inguinofemoral lymphadenectomy, superficial, including Cloquet's node
│   ├── 38765 — Inguinofemoral lymphadenectomy, superficial + pelvic
│   │               (external iliac, hypogastric, obturator) — unilateral, IN CONTINUITY
│   ├── 38770 — ⭐ Pelvic lymphadenectomy ONLY (external iliac, hypogastric, obturator) — unilateral
│   └── 38780 — Retroperitoneal transabdominal lymphadenectomy, extensive
│                   (pelvic + aortic + renal nodes — unilateral)
│
└── 38900 — Intraoperative identification of sentinel lymph node (list separately)

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🏥 Common ICD-10-CM Diagnoses Paired with 38770

🔴 Malignant Neoplasms (Primary Indications)

ICD-10-CM Code	Description	HCC Category	HCC Weight (v28 approx.)
C61	Malignant neoplasm of prostate	HCC 12	0.327
C67.9	Malignant neoplasm of bladder, unspecified	HCC 11	0.321
C67.0	Malignant neoplasm of trigone of bladder	HCC 11	0.321
C67.1	Malignant neoplasm of dome of bladder	HCC 11	0.321
C67.2	Malignant neoplasm of lateral wall of bladder	HCC 11	0.321
C67.3	Malignant neoplasm of anterior wall of bladder	HCC 11	0.321
C67.4	Malignant neoplasm of posterior wall of bladder	HCC 11	0.321
C67.5	Malignant neoplasm of bladder neck	HCC 11	0.321
C60.9	Malignant neoplasm of penis, unspecified	HCC 11	0.321
C60.0	Malignant neoplasm of prepuce	HCC 11	0.321
C60.1	Malignant neoplasm of glans penis	HCC 11	0.321
C62.90	Malignant neoplasm of testis, unspecified, unspecified side	HCC 11	0.321
C53.9	Malignant neoplasm of cervix uteri, unspecified	HCC 11	0.321
C54.1	Malignant neoplasm of endometrium	HCC 11	0.321
C54.2	Malignant neoplasm of myometrium	HCC 11	0.321
C55	Malignant neoplasm of uterus, part unspecified	HCC 11	0.321
C56.9	Malignant neoplasm of unspecified ovary	HCC 11	0.321
C51.9	Malignant neoplasm of vulva, unspecified	HCC 11	0.321

💡 HCC Note: Under CMS HCC v28, urologic and gynecologic malignancies predominantly map to HCC 11 (Bladder, Urinary Tract, Eye, and Other Cancers) and HCC 12 (Prostate, Breast, and Other Cancers and Tumors). These carry significant risk adjustment impact. Always ensure histological confirmation and specificity to the highest level of documented detail.

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🟡 Secondary / Metastatic Diagnoses (May Be Reported Concurrently)

ICD-10-CM Code	Description	HCC
C77.5	Secondary and unspecified malignant neoplasm of intrapelvic lymph nodes	HCC 8
C77.9	Secondary and unspecified malignant neoplasm of lymph node, unspecified	HCC 8
Z17.0	Estrogen receptor positive status	N/A
Z85.46	Personal history of malignant neoplasm of prostate	N/A
Z85.51	Personal history of malignant neoplasm of bladder	N/A

⚠️ Sequencing Tip: When lymphadenectomy is performed for staging of a primary malignancy, the primary cancer code leads. When performed therapeutically for known nodal metastases, both the primary and secondary nodal codes (C77.5) may be reported per UHDDS guidelines.

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🏨 MS-DRG Mapping

MS-DRG assignment is principal diagnosis-driven and further refined by the presence of a CC or MCC. 38770 maps to an OR procedure and will typically drive surgical MS-DRG assignment. Common pairings:

Clinical Context	MS-DRG (with MCC)	MS-DRG (with CC)	MS-DRG (w/o CC/MCC)
Prostate malignancy / Radical prostatectomy	714	715	716
Bladder malignancy / Radical cystectomy	673	674	675
Bladder malignancy / Cystectomy (other)	676	677	678
Penile/Urethral malignancy	673	674	675
Uterine/Cervical malignancy (GYN OR)	736	737	738
Ovarian malignancy (GYN OR)	736	737	738

💡 MS-DRG Tip: The CC/MCC designation is critical. Common MCCs in this population include sepsis, respiratory failure, and acute kidney injury. Common CCs include UTI, postoperative hemorrhage, DVT, and ileus. Capture all documented conditions that are evaluated, treated, or affect management to support accurate CC/MCC assignment.

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💉 Procedure Code Pairings — Common ICD-10-PCS (Inpatient)

For inpatient encounters, 38770 corresponds to ICD-10-PCS root operation Excision (B) or Resection (T) in the Lymphatic and Hemic Systems (7) body system:

ICD-10-PCS	Description
07BC0ZZ	Excision of pelvic lymphatic, open approach
07TC0ZZ	Resection of pelvic lymphatic, open approach
07BC4ZZ	Excision of pelvic lymphatic, percutaneous endoscopic (laparoscopic)
07TC4ZZ	Resection of pelvic lymphatic, percutaneous endoscopic

📝 PCS Note: Root operation selection between Excision (cutting out a portion) vs. Resection (cutting out all of a body part) should reflect what the operative note describes. A complete bilateral pelvic lymphadenectomy where the entire nodal basin is cleared = Resection. A sampling or partial dissection = Excision.

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🧪 Coding Examples

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✏️ Example 1 — Standalone Staging Pelvic Lymphadenectomy for Prostate Cancer (Outpatient/ASC)

Clinical Scenario:
A 67-year-old male with high-risk prostate cancer (C61) undergoes open pelvic lymphadenectomy prior to definitive radiation therapy. The surgeon performs a unilateral right-sided dissection of the external iliac, obturator, and hypogastric nodal basins. No radical prostatectomy is performed at this time.

CPT Reported:

• 38770 — Pelvic lymphadenectomy, external iliac, hypogastric, obturator (unilateral, right)

ICD-10-CM:

• C61 — Malignant neoplasm of prostate (primary)

Notes:
Since no radical prostatectomy was performed at this session, 38770 is not bundled and is separately reportable. If bilateral, report 38770-50 or two line items per payer preference.

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✏️ Example 2 — Pelvic Lymphadenectomy with Radical Prostatectomy (Beware Bundling)

Clinical Scenario:
Same patient undergoes robotic-assisted radical prostatectomy (55866) with bilateral pelvic lymph node dissection including external iliac, hypogastric, and obturator nodes.

CPT Reported (attempted):

• 55866 — Laparoscopic radical prostatectomy
• 38770-50 — (attempted bilateral pelvic lymphadenectomy)

Coding Alert:
Per NCCI edits, 38770 is bundled as a column 2 edit with 55866. The lymphadenectomy is considered integral to the radical prostatectomy when done at the same operative session. Do not separately report 38770 unless a payer-specific policy or clearly distinct, separately documented service justifies the use of a modifier.

ICD-10-CM:

• C61 — Malignant neoplasm of prostate

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✏️ Example 3 — Bladder Cancer with Pelvic Lymphadenectomy (Inpatient)

Clinical Scenario:
A 72-year-old female with muscle-invasive urothelial carcinoma of the posterior wall of the bladder (C67.4) undergoes open radical cystectomy with ileal conduit urinary diversion and bilateral pelvic lymphadenectomy. She has a documented history of hypertension (I10) and type 2 diabetes with CKD stage 3 (E11.22, N18.3).

CPT Reported (professional):

• 51570 — Cystectomy, complete (separate from urinary diversion)
• 50820 — Ureterosigmoidostomy (conduit)
• 38770-50 — Bilateral pelvic lymphadenectomy (verify NCCI edits with cystectomy code selection)

ICD-10-CM (inpatient sequencing):

1. C67.4 — Malignant neoplasm of posterior wall of bladder (PDX)
2. C77.5 — Secondary malignant neoplasm of intrapelvic lymph nodes (if nodes positive)
3. E11.22 — Type 2 diabetes mellitus with diabetic chronic kidney disease
4. N18.3 — Chronic kidney disease, stage 3
5. I10 — Essential hypertension

MS-DRG Assignment:

• C77.5 (secondary nodal malignancy) qualifies as an MCC → MS-DRG 673 (Kidney and Ureter Procedures for Neoplasm with MCC)

💡 If lymph nodes were pathologically negative, omit C77.5. The diabetes + CKD combination (E11.22 + N18.3) may fulfill CC criteria depending on CMS version — document thoroughly.

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✏️ Example 4 — Penile Cancer with Pelvic Lymphadenectomy (Following Prior Inguinal Dissection)

Clinical Scenario:
A 58-year-old male with squamous cell carcinoma of the glans penis (C60.1) who previously underwent bilateral inguinofemoral lymphadenectomy now returns for a left pelvic lymphadenectomy due to suspicious imaging of the left obturator and external iliac nodal chain.

CPT Reported:

• 38770 — Pelvic lymphadenectomy (left side only, not in continuity with inguinal dissection which was a prior, separate surgical episode)

ICD-10-CM:

1. C60.1 — Malignant neoplasm of glans penis (PDX)
2. C77.5 — Secondary malignant neoplasm of intrapelvic lymph nodes

Notes:
Because the inguinofemoral dissection was performed in a prior separate surgical encounter, 38770 is appropriate here. 38765 would be used if the inguinal and pelvic dissections were performed in continuity at the same operative session. Use of modifier -58 may apply if this is a staged procedure during the global period of the prior lymphadenectomy.

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📎 Modifier Guidance

Modifier	Use Case
-50	Bilateral procedure — apply when both left and right pelvic lymphadenectomies performed at same session
-LT / -RT	Designate laterality when only one side performed; some payers require in lieu of -50
-51	Multiple procedures — apply to secondary procedures when 38770 is not the primary CPT (some payers exempt)
-58	Staged/related procedure during global period (e.g., pelvic lymphadenectomy performed after a prior penile or inguinal procedure)
-59	Distinct procedural service — may be appropriate when documentation clearly supports 38770 as separate from a bundled primary procedure (use cautiously and with strong documentation support)
-80	Assistant surgeon
-82	Assistant surgeon (when qualified resident unavailable)

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📝 Operative Note Documentation Requirements

To support CPT 38770, the operative note should clearly document:

• Approach (open, laparoscopic, robotic)
• Laterality (right, left, bilateral)
• Specific node groups removed: external iliac, hypogastric/internal iliac, and obturator
• Identification and preservation (or sacrifice) of the obturator nerve
• Skeletonization of the iliac vessels
• Specimen submission (# of specimens, labels used)
• Estimated blood loss
• Any complication encountered intraoperatively (lymphocele prevention measures, vascular injury, etc.)
• Clinical indication (staging vs. therapeutic)

⚠️ Vague documentation such as “pelvic lymph node sampling” or “lymph node biopsy” will not support 38770. The note must reflect a complete dissection of all three nodal groups.

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🔑 Key Coding Pearls

💡 Laparoscopic vs. Open: There is no CPT-designated laparoscopic equivalent for a standalone pelvic lymphadenectomy within the 38xxx series. Some payers accept 38770 regardless of approach; others may direct use of 38571 or 38572 (laparoscopic pelvic lymph node dissection with colectomy — typically GI context). Verify with your payer. For robotic-assisted surgery, the approach does not change the CPT code.

💡 Bilateral Reporting: A unilateral pelvic lymphadenectomy = one unit of 38770. Bilateral = 38770-50 (or two line items with -LT/-RT) at 150% of the allowable.

💡 Bundling with Radical Prostatectomy: This is one of the most common billing errors in urology. 38770 is bundled into open and laparoscopic/robotic radical prostatectomy codes (55840, 55842, 55845, 55866). Always run NCCI checks before submitting.

💡 HCC Capture: The malignancies driving 38770 carry significant HCC weight. Ensure the histology, primary site specificity, and current vs. historical status are clearly coded. A current active malignancy codes differently than a personal history — do not under-code the active disease.

💡 Pathology Correlation: Code C77.5 (secondary intrapelvic lymph node malignancy) only when the pathology report confirms nodal involvement. Do not assign this code based on radiologic suspicion alone in the inpatient setting.

💡 Specimen Labeling: Pathology often receives specimens labeled by basin (e.g., “right obturator,” “left external iliac”). This granularity helps both the pathologist and the coder confirm that a complete dissection — not mere sampling — was performed.

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🔗 Related Codes Quick Reference

Code	Description
38760	Inguinofemoral lymphadenectomy, superficial only
38765	Inguinofemoral + pelvic lymphadenectomy, in continuity (unilateral)
38780	Retroperitoneal lymphadenectomy (pelvic + aortic + renal nodes)
55840	Radical prostatectomy, open (lymphadenectomy bundled)
55866	Radical prostatectomy, laparoscopic/robotic (lymphadenectomy bundled)
51570	Cystectomy, complete
58210	Radical abdominal hysterectomy (with pelvic lymphadenectomy bundled)
38571	Laparoscopic bilateral total pelvic lymphadenectomy
38572	Laparoscopic bilateral total pelvic lymphadenectomy + peri-aortic sampling
C61	Prostate malignancy
C67.9	Bladder malignancy
C77.5	Secondary malignant neoplasm, intrapelvic lymph nodes

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Last reviewed: 2025-03-11 | Verify wRVU and NCCI edits against current CMS Physician Fee Schedule and CMS NCCI Policy Manual prior to billing.