Otolaryngology Coding Alert

Question: Could you please explain the difference between the different types of neck dissection -- radical, modified radical, suprahyoid, and limited?

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Answer: Neck dissections refer to a procedure called "lymphandectomies," which is the removal of lymph nodes. A radical neck dissection, for instance 38720 (Cervical lymphandectomy, complete) is an en-bloc (all at the same time) clearance of all fibro fatty tissue from one side of the neck, including the lymph nodes from levels I-V and lymph nodes that surround the tail of the parotid gland, the spinal accessory nerve, the internal jugular vein, and the sternocleidomastoid muscle.

A modified neck dissection, such as 38724 (Cervical lymphadenectomy [modified radical neck dissection]) involves the removal of the same lymph node groups as those involved in the radical neck dissection (levels I-V) but requires preservation of one or more of the following three nonlymphatic structures: the spinal accessory nerve, the internal jugular vein, and the sternocleidomastoid muscle. The structure or structures preserved should be indicated in the op note. The current standard of practice is to perform a more conservative modified neck dissection if possible when performing a lymphandectomy.

A suprahyoid neck dissection is represented by 38700 (Suprahyoid lymphandectomy). This procedure dissects only the lymph nodes above the hyoid bone.

A limited or selected neck dissection, for instance 60252 (Thyroidectomy, total or subtotal for malignancy;with limited neck dissection), refers to a type of neck dissection in which the surgeon removes one or more lymph node groups in the predicted drainage pathways based on the site of the lesion.