Otolaryngology Coding Alert

Question: My otolaryngologist performs a selective neck dissection of levels 1-3. How should I bill this procedure? She preserves the internal jugular vein, spinal accessory nerve and sternocleidomastoid muscle. Would I use the same code for levels 2-4?

Ohio Subscriber

Answer: Anytime the otolaryngologist spends extra time dissecting out those structures and preserving or even trying to preserve them, you should use 38724 (Cervical lymphadenectomy [modified radical neck dissection]).

Because the physician modifies her surgical dissection plane to preserve some or all of those critical structures, she deserves the additional work value that the National Physician Fee Schedule assigns to that modification's complexity.

Snafu: CPT's cervical lymphadenectomy codes (38720-38724) don't correspond to the levels an otolaryngologist documents. You should instead look at whether the surgeon preserves anatomy. A selective neck dissection refers to a modified radical neck dissection (such as 38724), in which the otolaryngologist chooses to preserve certain structures. In a radical neck dissection (such as 38720), the surgeon removes everything.

- You Be the Coder and Reader Questions provided by Andrew Borden, CCS-P, CPC, CMA, reimbursement manager in the department of otolaryngology and communication sciences at Medical College of Wisconsin in Milwaukee; Rhonda Buckholtz, CPC, president of the Erie American Academy of Professional Coders chapter in Pennsylvania; and Barbara Cobuzzi, MBA, CPC, CPC-H, CHBME, an otolaryngology coding and reimbursement specialist and president of Cash Flow Solutions, a medical billing firm in Brick, N.J.