Summary & Overview
CPT 38747: Abdominal Lymphadenectomy, Add-On
CPT code 38747 denotes an add-on abdominal lymphadenectomy performed with another primary intra-abdominal procedure to remove regional lymph nodes, commonly for cancers of the intestines, stomach, pancreas, or other abdominal organs. As an add-on surgical code, it captures the distinct work and resources required to extend a primary abdominal operation to include comprehensive lymph node removal, often involving nodes near major vascular structures. Nationally, accurate use of this code affects quality reporting, surgical case mix, and hospital/provider billing for oncologic surgeries.
Key payers in typical analyses include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise overview of coding intent and clinical context, payer coverage expectations, and practical considerations for service classification. The publication covers benchmarking and claim-level patterns, common modifier usage where available, and implications for documentation and operative reporting to support correct coding. The content is intended for revenue cycle professionals, surgical teams, and policy analysts seeking a focused reference on CPT code 38747 and its role in abdominal oncologic surgery.
Billing Code Overview
CPT code 38747 is an add-on surgical procedure for abdominal lymphadenectomy performed in conjunction with another primary abdominal operation. The procedure involves an incision of the abdomen and removal of abdominal lymph nodes, including nodes of the stomach and pancreas, and may include nodes adjacent to the aorta and vena cava. Clinicians commonly perform this procedure to remove regional lymph nodes for malignancies of the intestines, stomach, pancreas, or other intra-abdominal organs or structures.
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Service type: Surgical add-on procedure (abdominal lymph node dissection)
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Typical site of service: Hospital operating room or ambulatory surgical center during an intra-abdominal cancer operation
Data not available in the input for modifiers, associated taxonomies, and specific ICD-10 diagnoses.
Clinical & Coding Specifications
Clinical Context
A typical patient is a 62-year-old with a gastric adenocarcinoma or pancreatic head malignancy scheduled for an open exploratory laparotomy with tumor resection. Preoperative evaluation includes staging imaging (CT abdomen/pelvis, possible PET), oncology consultation, and informed consent for primary resection (for example, partial gastrectomy or pancreaticoduodenectomy) with planned regional lymphadenectomy. Intraoperatively the surgeon performs the primary resection (e.g., CPT 48150 partial gastrectomy or CPT 48150 if subtotal gastrectomy; see coding table for commonly paired codes) and then performs an extended abdominal lymph node dissection through the abdominal incision, removing perigastric, pancreaticoduodenal, and optionally paracaval and para-aortic nodes. Specimens are sent to pathology for nodal staging. Typical postoperative workflow includes recovery in PACU, inpatient monitoring for potential complications (hemorrhage, infection, anastomotic leak), pathology review with TNM staging, multidisciplinary tumor board discussion, and planning adjuvant therapy if indicated. The procedure is performed in an operating room; typical sites of service are inpatient acute care hospitals or ambulatory surgery centers when clinically appropriate but most commonly inpatient hospital setting for major resections.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
22 |