General Surgery Coding Alert

Question: Our surgeon performed an open selective neck dissection, removing cervical lymph nodes while preserving the internal jugular vein, spinal accessory nerve, and sternocleidomastoid muscle. Should we report this as 38510, 38724, or some other code?

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Answer: The best choice for the procedure you describe is 38724 (Cervical lymphadenectomy [modified radical neck dissection]). Because the physician modifies the surgical dissection plane to preserve some or all of those critical structures mentioned in the report, the work clearly warrants a dissection code rather than a biopsy code.

Don't code biopsy: A selective neck dissection represents a lymphadenectomy of the cervical nodes, not a biopsy. A biopsy involves removing one or a few lymph nodes -- from the cervical region for purposes of this discussion. For an open biopsy, you would choose one of the following codes depending on whether the nodes are superficial (not far below the skin) or deep:

• 38500 -- Biopsy or excision of lymph node(s); open, superficial
• 38510 -- ... open, deep cervical node(s).

Choose 'modified': CPT® provides the following codes for neck dissection:

• 38720 --Cervical lymphadenectomy (complete)
• 38724 -- Cervical lymphadenectomy (modified radical neck dissection).

Look at whether the surgeon preserves anatomy to help you decide between the two codes. A selective neck dissection refers to a modified radical neck dissection in which the physician chooses to preserve certain structures. In a radical neck dissection (such as 38720), the surgeon removes lymph nodes and surrounding tissues.