CPT® Code 38746

Add-On Code

Thoracic lymphadenectomy by thoracotomy, mediastinal and regional lymphadenectomy (List separately in addition to code for primary procedure)

Thoracic lymphadenectomy by thoracotomy, as denoted by CPT® Code 38746, involves the surgical removal of lymph nodes located in the thoracic region, specifically when there is evidence of malignant neoplasm metastasis to these nodes. The thoracic lymph nodes encompass various types, including intrapulmonary nodes, bronchopulmonary (hilar) nodes, tracheobronchial nodes, peritracheal nodes, intercostal nodes, mediastinal nodes, and parasternal nodes. This procedure is typically performed in conjunction with another thoracic surgical procedure that necessitates a thoracotomy, which is an incision into the chest wall. The surgeon identifies the affected lymph node chains, often utilizing lymph node mapping techniques to locate the sentinel node, which is the first node to which cancer cells are likely to spread from the primary tumor. Once the involved lymph nodes are located, they are meticulously dissected from the surrounding tissues, with particular attention given to preserving adjacent blood vessels and nerves. The excised lymph nodes are subsequently sent for pathological examination to assess the presence of cancerous cells, which is crucial for determining the extent of disease and guiding further treatment options.