Summary & Overview
CPT 38770: Excision of Pelvic Lymph Nodes
CPT code 38770 denotes surgical excision of pelvic lymph nodes — specifically the external iliac, hypogastric, and obturator nodes — most often performed for cancer staging or treatment in the lower abdomen and pelvis. Nationally, this code is important for oncology surgical workflows, perioperative resource planning, and coding accuracy tied to cancer care pathways.
Key payers covered in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise overview of clinical context for the procedure, the typical sites of service, and the common modifiers associated with surgical services. The publication also summarizes benchmarking and reimbursement considerations, coding nuances relevant to pelvic lymphadenectomy, and notes on documentation that influence claim adjudication.
This summary provides clinicians, coding teams, and revenue cycle professionals with the essential facts about CPT code 38770, helping stakeholders align clinical documentation with billing practices and understand where policy updates or payer-specific rules may affect processing and coverage determinations.
Billing Code Overview
CPT code 38770 describes the surgical excision of pelvic lymph nodes, including the external iliac, hypogastric, and obturator nodal groups. This procedure is commonly performed for oncologic staging and treatment when malignancy involves the lower abdomen or pelvic organs.
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Service type: Surgical excision of pelvic lymph nodes
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Typical site of service: Operating room or surgical suite, inpatient or outpatient hospital setting
Clinical & Coding Specifications
Clinical Context
A 62-year-old female with newly diagnosed high-grade endometrial carcinoma is scheduled for surgical staging including total abdominal hysterectomy, bilateral salpingo-oophorectomy, and pelvic lymphadenectomy. Preoperative workup includes pelvic MRI and CT chest to evaluate for metastatic disease and anesthesia assessment. In the operating room under general anesthesia, the surgeon performs an open or minimally invasive pelvic lymph node dissection targeting the external iliac, internal (hypogastric), and obturator nodal basins to obtain nodes for pathologic staging and to guide adjuvant therapy decisions. Intraoperative steps include identification of vascular landmarks, careful nodal packet excision with hemostasis, possible specimen labeling for laterality, and sending nodes for frozen section or permanent histopathology. Postoperative workflow includes immediate recovery in PACU, pain control, DVT prophylaxis, wound checks, and coordination with oncology for final pathology and adjuvant treatment planning.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
50 | Bilateral procedure | When pelvic lymphadenectomy is billed for bilateral nodal basins as a single operative session and payer requires explicit bilateral modifier |
62 |