Thoracic Duct Disruption

May 18, 2017

Question:

In cases of chyle leak/chylous effusion, in addition to the codes for the lymphangiography, should anything be billed for the disruption of the thoracic duct, which sometimes happens in the attempt to access it for embolization? I question since they state the disruption is often therapeutic in and of itself. I'm looking at code 38794 possibly with a -52 modifier appended? "IMPRESSION: Lymphangiography performed with 20 ml of lipiodol instilled via a bilateral groin nodes. The thoracic duct was well opacified. A small leak is present on the right at the level of T8. I was unable to cannulate the thoracic duct. After numerous passes through both the cisterna chyli and the thoracic duct in the upper abdomen, the thoracic duct and cisterna chyli were disrupted. Stasis of flow in the thoracic duct was noted at the end of the case. PLAN: Follow for reaccumulation." In the setting of low volume leak, lymphangiography with thoracic duct disruption is often therapeutic despite failure to embolize the thoracic duct.

Question ID: 9336
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