Cracking the Code

Lymphovenous Bypass

For outpatient settings, coders will sometimes report unlisted CPT codes for certain procedures. Unlisted procedure codes are assigned when submitting claims for procedures/services where a CPT/HCPCS code is not otherwise specified. Unlisted codes provide the means of reporting and tracking services and procedures until a more specified code is established. For example, The LYMPHA (Lymphatic Microsurgical Preventative Healing Approach) technique, also known as lymphovenous bypass, has been shown to help reduce the risk of lymphedema. It’s offered for patients who need an axillary lymph node dissection because cancer has spread into their lymph nodes.

When reporting this procedure, it is appropriate for coders to assign CPT 38999, unlisted procedure, hemic or lymphatic system. Per CPT Assistant guidance, there are no specific CPT codes to describe procedures to decrease lymphedema with physiologic microsurgery involving lymphatico-lymphatic, lympho-venous, lymphaticovenous anastomosis, and autologous lymph node transplantation or lymph node transfer as performed by surgeons following breast cancer.

Q: Following a modified radical mastectomy of the left breast, a lymphovenous bypass was performed to reroute the lymphatic channels into the veins to prevent potential blockage in the lymphatic system and to allow excess lymph fluid to flow freely.
A: CPT 38999, unlisted procedure, hemic or lymphatic system
Reference: CPT ASST October 2021, Volume 31, Issue 10, page 4
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