Lymphadenectomies

Lori.Drodge@mainehealth.org

We are exploring a thought about the possibility of coding lymphadenectomies by using the number of lymph nodes specified in the path report if the op note is not clear about partial vs entire removal of a lymph node chain.  Review of the path report guideline notes discussion of how diagnoses cannot be coded without confirmation by the attending.  However, there is no discussion of using other portions of the report for code assignment.  The use of these details may be appropriate when considering Coding Clinic 1Q99p5.  This states that a diagnosis of “fracture” cannot be coded directly from an x-ray but the details of the diagnosis (i.e. fracture site) can be coded if only noted in the x-ray report.  OP notes typically outline the borders of dissection but do not specify the information needed for coding.

 Our theory:  If we could outline the number of lymph nodes present in each region (for example:  4-6 left pelvic nodes) and the path report notes that 6 nodes were analyzed, this would support coding a “radical” lymphadenectomy.

Has anyone created a process for a similar thought to compliantly assigned codes using the path report information for lymphadenectomies? 

 

cindys@hollandhospital.org

We do NOT use pathology reports, Per our surgeons - Multiple lymph node removal needs provider clarification.

Per our surgeons, NO QUERY IS NEEDED if one of the following is documented:

* Lymph node chain

*Lymph node "packet"

*Radical resection/dissection of lymph nodes

*Modified radical resection of lymph nodes

* Level 1,2, or 3 - each level is considered a chain

*R1, R2, R3 - each level is considered a chain

ANY OTHER documentation of multiple lymph nodes would need to be queried.

Note:  The intent of a chain resection is to remove all lymph nodes in the area, most often will be done

            with known cancers.

Lori.Drodge@mainehealth.org

Thank you for sharing your thoughts Quincy.  I agree and we are aware of this information but these details are often not present after providing education for an extended period of time (which we will continue to do).  We are wondering if anyone has created a compliant process as outlined above. 

katysuegood@gmail.com

Have you considered creating a Procedure note specific to this procedure that prompts for this information? This is what we have done excisional debridement's.

I would not be comfortable coding off of the path note and would advocate creating a process for the provider to include this info if possible..

Katy Good