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CODING TIPS & TRICKS Retroperitoneal Lymph Node Dissection and Mass Excision: Terminology and Coding

By: Jonathan Rubenstein, MD, Compliance Officer, United Urology Group, Current Procedural Terminology Advisor, AUA | Posted on: 13 May 2025

In oncologic surgery involving the retroperitoneum, some surgeons incorrectly use the term “retroperitoneal lymph node dissection” (RPLND) to describe any procedure involving lymph node removal, even when distinct tumor masses are present in the area. Additionally, some may report an RPLND for mass removal without actually removing lymph nodes. It is essential for both surgeons and coders to understand that there are separate Current Procedural Terminology (CPT) codes for lymph node dissection and mass removal, and in some cases, both codes may apply. This article aims to clarify proper documentation and coding practices.

Lymph node dissection involves the removal of multiple lymph nodes, usually nonenlarged or mildly enlarged, from a specific area of the body to check for metastasis, either for diagnostic or therapeutic purposes. Typically, a predefined template or cluster of lymph nodes is removed, often guided by imaging or an understanding of the cancer's typical spread patterns. Examples of this procedure include sentinel lymph node biopsy and radical lymph node dissection. Several CPT codes can be used to report various types of lymph node dissections (Tables 1 and 2), and in some surgeries, certain CPT codes for the primary procedure may already include lymph node dissection when performed.

Table 1. Common Open Lymph Node Dissection Current Procedural Terminology Codes Used in Urology

Code

Descriptor

Notes

38562

Limited lymphadenectomy for staging (separate procedure); pelvic and para-aortic

 

38564

Limited lymphadenectomy for staging (separate procedure); retroperitoneal (aortic and/or splenic)

 

+38747

Abdominal lymphadenectomy, regional, including celiac, gastric, portal, peripancreatic, with or without para-aortic and vena caval nodes

List separately in addition to code for primary procedure

38760

Inguinofemoral lymphadenectomy, superficial, including Cloquet’s node (separate procedure)

For bilateral procedure, report 38760 with modifier 50

38765

Inguinofemoral lymphadenectomy, superficial, in continuity with pelvic lymphadenectomy, including external iliac, hypogastric, and obturator nodes (separate procedure)

For bilateral procedure, report 38765 with modifier 50

38770

Pelvic lymphadenectomy, including external iliac, hypogastric, and obturator nodes (separate procedure)

For bilateral procedure, report 38770 with modifier 50

38780

Retroperitoneal transabdominal lymphadenectomy, extensive, including pelvic, aortic, and renal nodes (separate procedure)

 

 

Table 2. Common Laparoscopic Lymph Node Dissection Current Procedural Terminology Codes Used in Urology

Code

Descriptor

Notes

38570

Laparoscopy, surgical; with retroperitoneal lymph node sampling (biopsy), single or multiple

Use if retroperitoneal node(s) are sampled or removed, if medically necessary and not included in the base code

38571

… with bilateral total pelvic lymphadenectomy

Use if a bilateral total lymphadenectomy is performed, medically necessary and not included in the base code

38572

… with bilateral total pelvic lymphadenectomy and periaortic lymph node sampling (biopsy), single or multiple

Use if a bilateral total lymphadenectomy and periaortic nodes are sampled, if performed and medically necessary and not included in the base code

38573

… with bilateral total pelvic lymphadenectomy and periaortic lymph node sampling, peritoneal washings, peritoneal biopsy(ies), omentectomy, and diaphragmatic washings, including diaphragmatic and other serosal biopsy(ies), when performed

Use if these node(s) and procedure(s) are performed and are medically necessary and if not included in the base code

38589

Unlisted laparoscopy procedure, lymphatic system

 

In contrast, mass removal involves the surgical removal of one or more abnormal growths or masses, which are typically known malignant metastases. In retroperitoneal oncologic surgery, these masses may be residual masses after chemotherapy or radiation therapy, or masses that are treatment naïve. The goal of the surgery is to remove the mass for diagnostic or therapeutic purposes, alleviate symptoms caused by the mass pressing on nearby structures, and prevent further progression or spread if the mass is malignant. The dissection focuses on the specific mass and surrounding tissues, if necessary, to ensure clear margins. Often this procedure involves less surrounding tissue than a lymph node dissection, unless the mass is invasive. In 2025, there were 5 new CPT codes that became available to report the open excision or destruction of retroperitoneal masses (Table 3). There are no corresponding laparoscopic codes available at this time.

Table 3. Current Procedural Terminology Codes Describing the Open Excision or Destruction of Retroperitoneal Masses

Code

Descriptor

49186

Excision or destruction, open, intra-abdominal (ie, peritoneal, mesenteric, retroperitoneal), primary or secondary tumor(s) or cyst(s), sum of the maximum length of tumor(s) or cyst(s) 5 cm or less

49187

… 5.1-10 cm

49188

… 10.1-20 cm

49189

… 20.1-30 cm

49190

… >30 cm

These 5 codes (49186-49190) describe the excision or destruction of intra-abdominal primary or secondary tumors or cysts via an open approach. This process includes cytoreduction, debulking, or other tumor or cyst removal methods. Codes 49186 to 49190 are reported based on the total maximum length of each tumor or cyst excised or destroyed (eg, ultrasound desiccation). Only the tumors and cysts themselves are measured, excluding the surrounding tissue (eg, mesentery) in which they may be implanted. If only a portion of a tumor or cyst is removed or destroyed, only that portion is measured.

The tumors and cysts should be measured in situ before excision or destruction, with the measurements documented in the operative report. Measurement includes only the tumor(s) and cyst(s), not the margins. These codes (49186-49190) apply when the resected or destroyed intra-abdominal tumors or cysts do not originate directly from a resected organ (eg, small bowel mass, renal mass, liver mass) or soft tissue that may be reported separately. When tumors originate from an organ or soft tissue, only the respective organ or soft tissue resection or destruction code should be reported.

In oncologic retroperitoneal surgery, there are instances where a surgeon may perform an RPLND alongside a mass excision. If both procedures are medically necessary, performed, and properly documented, they can be reported separately.

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