Otolaryngology Coding Alert

Question: Encounter notes indicate that a patient reports to the otolaryngologist for lymph node removal. The physician wrote “MRND” in the procedure notes, but little else. Do you have any idea what code[s] I might choose for MRND?

Oklahoma Subscriber

Answer: When you provider performs neck dissection, or lymphadenectomy, you have a few code choices depending on the specifics of the procedure. The “MRND” acronym usually means “modified radical neck dissection,” which you’d code with 38724 (Cervical lymphadenectomy [modified radical neck dissection]). Go back and check with your provider on this code, but it sounds as if you should be reporting 38724 in this instance.

There are some other codes for other types of lymphadenectomies as well. Here’s a quick look at the specifics of some of the more common neck dissection codes:

38700: If the physician removes lymph nodes above the hyoid, or in other limited neck areas, choose 38700 (Suprahyoid lymphadenectomy).

38720: If the physician removes all of the neck lymph nodes from levels 1-5, the sternocleidomastoid muscle, the spinal accessory nerve, and the jugular vein, report 38720 (Cervical lymphadenectomy [complete]). So let’s say encounter notes indicate that the physician removed neck lymph nodes from levels 1-5, along with the spinal accessory nerve, sternocleidomastoid muscle, and jugular vein. In this instance, you’d report 38720.

38724: If the physician removes all of the neck lymph nodes from levels 1-5—but leaves one or more of the adjacent structures intact—your report 38724. These adjacent structures are the sternocleidomastoid muscle, the spinal accessory nerve, and the jugular vein. So let’s say encounter notes indicate that the physician removed neck lymph nodes from levels 1-5, along with the spinal accessory nerve. The physician spared the sternocleidomastoid muscle and jugular vein. In this instance, you’d report 38724.

Modifier alert: All of the aforementioned neck dissection codes are unilateral, so you’ll want to append a modifier when you perform the procedure bilaterally. The modifier you choose isn’t always cut-and-dried, however.

CPT^® wants coders to attach modifier 50 (Bilateral procedure) to any of the neck dissection codes when your provider performs the same procedure bilaterally. Some payers, however, don’t share CPT^®’s view on modifier 50.

Do this: If a payer won’t allow modifier 50 for bilateral neck dissections, check with the payer to see how you can code for the procedures. Other options include reporting the neck dissection code on two separate lines, with modifier 59 (Distinct procedural service). If the payer prefers the X modifiers, choose XS (Separate structure) instead of 59.

In addition to using modifier 59/XS, you might also append modifier LT (Left side) and RT (Right side) to the neck dissection codes to further explain the bilaterality of the procedures.