Otolaryngology Coding Alert

Question: How do you code a level 6 neck dissection, also known as a central neck dissection?

Massachusetts Subscriber

Answer: The most accurate code for this is 38999 (Unlisted procedure, hemic or lymphatic system). Central compartment neck dissection refers to the bilateral removal of lymph nodes surrounding the midline visceral structures of the anterior neck. The lymph nodes include the pre- and paratracheal, pre-cricoid and perithyroidal. The upper limit of the dissection is the hyoid bone; the lower limit is the suprasternal notch; and the lateral limits are the carotid arteries.

Consider this: Another possibility is 38724-52 (Cervical lymphadenectomy [modified radical neck dissection]). You'd append modifier 52 (Reduced services) because 38724 is a more extensive procedure - it means removal of all lymph nodes from the neck. You might suggest this coding as a comparison for fee selection when you submit 38999. It's always a good idea to spell out the scope of an unlisted procedure, rather than leaving it to the discretion of the payer.

Watch out: Don't use 38700 (Suprahyoid lymphadenectomy); your ENT is doing much more work when she performs a central neck dissection.