# Selective Neck Dissections



## ctawney

My Dr. did right and left selective neck dissections and I cannot seem to find a code that works for this.  We have looked and 38724 and 38542, he does not agree with either.  Please Help!!!!

Postoperative Diagnosis: Papillary Thyroid Cancer with metastasis to the left cervical lymph nodes

Procedure: Right and Left Selective Neck Dissections

Procedure:
She was brought to the operating room where general anethesia was administered.  She was placed in a head-up neck-extended position.  The neck was prepped and draped in  sterile fashion.  The previous incision was injected with local anesthetic and the patient had a bit of hypertrophic scar which was excised.  This incision was then deepened through the subcutaneous tissue using electrocautery.  Electrocautery was used to dissect  down to and through the platysma which extenededto a plane of the previous flaps which then restored the plave dissecting to the thyroid cartilage superiorly into the sternal notch inferiorly.  A fixed retractor was placed and we bagan dissection on the patient's left side.  First we opened the straps but the central compartment was not accessible due to the scar tissue and adhesions.  We then went lateral to the straps and dissected between the straps and the sternocleidomastoid muscle.  The internal jugularvein was identified.  We divided the omohyoid muscle.  A time-consuming and tedious dissection then ensued as we identified the carotid artery and the vagus nerve.  We dissected the lymph node package from the supraclavicular fossa as high as we could reach.  Clips were used as well as LigaSure throughout and ultimately the left selective lymph package was delivered from the operatve field.  We then turned out attention to the right side where again, we dissected between the straps and the sternocleidomastoid muscle.  The vein was identified which was much larger on the right side.  Time-consuming and tedious dissection ensued as we dissected the soft tissues free from the vein and then free of the supraclavicular fossa being cognizant not to injure any of the nerves in the area and ultimately we freed the soft tissues from the vein surface from the supraclavicular fossa area and from high in the neckand this specimen was delivered from the operative field.  We then irrigated both sides, obtained hemostasis with bipolar cautery and clips.  We were satisfied, the muscles were reapproximated with interrupted 2-0 Vicryl.  The playsma layer was then approximated with 3-0 Polysorb sutur followed by some 3-0 Polysorb in the deep dermis and the skin was closed with a running 4-0 nylon subcuticular stitch.  Dressings were applied. 

Thanks!!!


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## Lujanwj

38724 is correct. 

CPT Assist 8/10

Selective Neck Dissection (SND): Removal of a subset of lymph node groups (levels) routinely removed in an RND or MRND. SND typically preserves nonlymphatic structures (SAN, SCM, and IJV) but may also involve their sacrifice. While code 38700 is properly used to code the very limited SHND involving level I only, all other SNDs are reported with CPT code 38724, Cervical lymphadenectomy .


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