In simple words: This is a surgical procedure where the doctor makes an incision in the chest to remove lymph nodes. Lymph nodes are small glands that filter waste and help fight infection.The doctor removes these nodes to check for cancer or treat it if it's present. This procedure is always done along with another, main operation.

Thoracic lymphadenectomy by thoracotomy entails a surgical incision into the chest (thoracotomy) to access and remove lymph nodes from the mediastinum and surrounding regions.The mediastinum is the central compartment of the thorax, containing the heart, trachea, and major blood vessels. Lymph node removal may be necessary for staging or treating malignancies such as lung cancer, breast cancer, or lymphoma. The procedure involves meticulous dissection to avoid damaging surrounding structures. Hemostasis (stopping bleeding) is crucial.The procedure is performed in conjunction with a primary procedure, and the code is reported separately. The location of mediastinal lymph nodes includes paratracheal, subcarinal, paraesophageal, and inferior pulmonary ligament nodes (on both right and left sides).

Example 1: A patient diagnosed with stage II lung cancer undergoes a lobectomy (removal of a lung lobe). During the lobectomy, the surgeon also performs a 38746 procedure to assess regional lymph node involvement for staging purposes., A patient with suspected mediastinal lymphoma undergoes a mediastinotomy (incision into the mediastinum) and lymph node biopsy. Code 38746 is added on to the mediastinotomy to reflect the extent of the lymph node sampling., A patient presents with a large mass in the chest wall, ultimately diagnosed as metastatic breast cancer.The surgeon performs a wide local excision of the chest wall mass and uses code 38746 to describe the extensive regional lymph node dissection necessary to clear the area of potential cancer spread.

The documentation should include a complete history and physical examination focusing on the patient's chief complaint and relevant symptoms, including imaging studies (chest X-ray, CT scan) indicating the location and extent of the disease, operative report detailing the type of thoracotomy, number and location of lymph nodes removed, pathology report with the results of lymph node examination (for diagnosis and staging), and post-operative progress notes.

** Code 38746 is typically reported with codes for primary procedures such as lung resections, mediastinotomies, or chest wall resections. The number of lymph nodes removed is not a determinant for code selection.The presence or absence ofmetastasis (cancer spread) should be documented to support the medical necessity of the lymph node dissection.