Summary & Overview
CPT 38746: Thoracic and Mediastinal Lymph Node Removal, Add-on Procedure
CPT code 38746 designates an add-on surgical procedure for incision of the chest with removal of thoracic and mediastinal lymph nodes, typically performed alongside a primary operative procedure for cancers of the breast, lung, or chest wall. As an add-on code, 38746 captures the additional work and resources associated with targeted lymphadenectomy in the thorax and mediastinum rather than a standalone operation. Nationally, accurate use of this code affects surgical claims, provider documentation, and case-cost accounting for complex oncologic procedures.
Key payers in this treatment area include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find clinical context for when the procedure is applied, coding considerations tied to its add-on status, and benchmarking context where available. The publication outlines expected sites of service (hospital inpatient and outpatient operating rooms, and select ambulatory surgery centers) and clarifies that the procedure is performed in combination with another primary procedure.
The review provides concise guidance on claims reporting implications of add-on status, documentation elements that support medical necessity for thoracic/mediastinal lymph node removal, and a summary of common modifiers associated with complex surgical episodes. Data not available in the input will be noted as such in relevant sections.
Billing Code Overview
CPT code 38746 is an add-on surgical procedure for incision of the chest with removal of thoracic and mediastinal lymph nodes. The procedure is typically performed when lymph node removal is required for malignancies such as breast cancer, lung cancer, or tumors of the chest wall. This add-on code is reported in conjunction with a separate primary operative procedure.
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Service type: Surgical, lymphadenectomy (thoracic/mediastinal)
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Typical site of service: Hospital inpatient or hospital outpatient operating room; may also occur in ambulatory surgery centers when clinically appropriate
Clinical & Coding Specifications
Clinical Context
A 62-year-old female with a newly diagnosed left-sided non-small cell lung carcinoma is scheduled for surgical resection. Preoperative imaging shows a primary tumor in the upper lobe with suspected regional nodal involvement. The thoracic surgical team performs a lobectomy as the primary procedure and, as an add-on, performs thoracic and mediastinal lymph node dissection and removal to obtain staging information and potential therapeutic benefit.
The clinical workflow: the patient undergoes preoperative evaluation (history, physical, chest CT/PET, pulmonary function testing). In the operating room under general anesthesia, the surgeon opens the chest via thoracotomy or video-assisted thoracoscopic approach, performs the primary tumor resection (for example lobectomy), then proceeds to systematically incise the chest and remove thoracic and mediastinal lymph nodes for pathologic staging. Specimens are labeled and sent to pathology. Postoperative care includes monitoring in recovery, pain control, chest tube management, and pathologic correlation for final staging and adjuvant therapy planning.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
62 | Two surgeons | When two surgeons with distinct surgical roles simultaneously perform portions of the operation. |