Summary & Overview
CPT 38765: Inguinofemoral and Pelvic Lymph Node Excision
CPT code 38765 represents surgical excision of superficial inguinofemoral lymph nodes with concurrent removal of pelvic lymph nodes (external iliac, hypogastric, and obturator). This procedure is primarily used in oncologic management when disease affects both the groin and pelvic nodal basins. Nationally, accurate coding for this operation is important for surgical case mix reporting, quality measurement, and appropriate claims processing for complex oncologic care.
Key payers discussed include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. The analysis covers how payers categorize and reimburse lymphadenectomy procedures, typical sites of service, and common clinical contexts prompting the combined inguinofemoral and pelvic node excision.
Readers will gain a clear description of the clinical service represented by the code, typical surgical setting and indications, and an overview of payer coverage landscape. The publication also outlines benchmarks and policy-relevant considerations affecting billing and claims adjudication for complex surgical oncology procedures. Data not available in the input for specific payor rate tables, ICD-10 pairings, and associated taxonomies are noted as unavailable.
Billing Code Overview
CPT code 38765 describes a surgical procedure in which the provider excises the superficial inguinofemoral lymph nodes (groin and upper thigh) and removes pelvic nodes, including the external iliac, hypogastric, and obturator nodes. The procedure targets lymphatic tissue in the inguinal and pelvic regions while excluding lymph nodes located deep beneath muscle layers.
Service Type: Surgical excision of superficial inguinofemoral and pelvic lymph nodes
Typical Site of Service: Operating room or surgical suite, commonly performed for oncologic indications involving cancers of the lower abdomen, groin, or pelvic region where both superficial and pelvic nodal clearance is indicated.
Clinical & Coding Specifications
Clinical Context
A 62-year-old female with a history of vulvar squamous cell carcinoma presents for planned surgical management of regional disease. Preoperative imaging (pelvic CT and PET/CT) demonstrates suspicious enlarged superficial inguinal and pelvic lymph nodes. The surgical oncology team schedules an inguinofemoral and pelvic lymphadenectomy to control regional nodal metastasis. The patient undergoes general anesthesia in an operating room with standard perioperative antibiotics and venous thromboembolism prophylaxis. The surgeon makes an inguinal incision to excise superficial inguinofemoral nodes and performs pelvic dissection to remove external iliac, hypogastric (internal iliac), and obturator lymph nodes. Specimens are labeled and sent for frozen section and permanent pathology. Postoperative workflow includes monitoring in PACU, inpatient pain control and wound care, DVT surveillance, pathology review to guide adjuvant therapy decisions, and coordination with medical and radiation oncology for staging-based treatment planning.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
11 | Normal, or expected, postoperative course | Use when the procedure is performed and recovery is uncomplicated. |
22 | Increased procedural services |