I need assistance with determining the most appropriate code for the procedure below - I am seeing several different options, yet I am not sure any one of them are correct. 38510 vs 38520 vs 38720 vs 38724 or something else? Procedure and path report provided.
OP Report
PREOPERATIVE DIAGNOSIS: Left neck mass, possible deep space lipoma, level 4
PROCEDURE PERFORMED: Left selective neck dissection, level 4
POSTOPERATIVE DIAGNOSIS: Left neck mass, possible deep space lipoma, level 4
Findings: The left lower neck in the region of level 4 was notable for a dense mobile area of fibrofatty tissue surrounded by more loosely organized fatty tissue. All of the node bearing fibrofatty tissue in level 4 was removed, and there were no other remarkable findings.
PROCEDURE DETAIL:
A 4 cm transverse incision was made in the inferior medial left neck. The fibers of the platysma were identified, and were separated vertically allowing access to the underlying tissue without transecting the platysma. The fascia along the medial border of the sternocleidomastoid was incised, allowing access to neck level 4. Fibrofatty tissue medial to the sternocleidomastoid was then dissected between the omohyoid above and the clavicle below. Care was taken to avoid injury to the internal jugular and the carotid artery. During this dissection, it was possible to palpate a firm rubbery mobile 2 cm mass within the
fibrofatty tissue. The mass was compressible in a way which felt consistent with lipoma tissue. When all of the fibrofatty contents of neck level 4 had been dissected away from surrounding structures, the tissue was delivered from the wound and sent to pathology for histologic evaluation. Hemostasis was achieved using bipolar electrocautery. The wound was then irrigated with saline. Because there was minimal seeping fluid within the wound, and no evidence of lymphatic leak, it was felt that the wound could be closed without a drain. The subcutaneous tissues were reapproximated using interrupted 4-0 chromic suture. The skin was closed using subcuticular 4-0 Prolene suture.
Pathology:
Specimen: Neck, contents left neck level 4
A. Left neck level 4 contents, selective neck dissection: Three benign lymph nodes (0/3). Surrounding benign, mature fibroadipose tissue.
Neck mass
A. Neck
Received fresh designated contents left neck level 4 is a 4 x 2 x 1.5 cm fragment of adipose tissue containing a 2 x 1 cm node and 2 0.3 cm nodes. The large node is trisected and entirely submitted in A 1 and A2. 2 small nodes inked black and submitted whole in A 1.
OP Report
PREOPERATIVE DIAGNOSIS: Left neck mass, possible deep space lipoma, level 4
PROCEDURE PERFORMED: Left selective neck dissection, level 4
POSTOPERATIVE DIAGNOSIS: Left neck mass, possible deep space lipoma, level 4
Findings: The left lower neck in the region of level 4 was notable for a dense mobile area of fibrofatty tissue surrounded by more loosely organized fatty tissue. All of the node bearing fibrofatty tissue in level 4 was removed, and there were no other remarkable findings.
PROCEDURE DETAIL:
A 4 cm transverse incision was made in the inferior medial left neck. The fibers of the platysma were identified, and were separated vertically allowing access to the underlying tissue without transecting the platysma. The fascia along the medial border of the sternocleidomastoid was incised, allowing access to neck level 4. Fibrofatty tissue medial to the sternocleidomastoid was then dissected between the omohyoid above and the clavicle below. Care was taken to avoid injury to the internal jugular and the carotid artery. During this dissection, it was possible to palpate a firm rubbery mobile 2 cm mass within the
fibrofatty tissue. The mass was compressible in a way which felt consistent with lipoma tissue. When all of the fibrofatty contents of neck level 4 had been dissected away from surrounding structures, the tissue was delivered from the wound and sent to pathology for histologic evaluation. Hemostasis was achieved using bipolar electrocautery. The wound was then irrigated with saline. Because there was minimal seeping fluid within the wound, and no evidence of lymphatic leak, it was felt that the wound could be closed without a drain. The subcutaneous tissues were reapproximated using interrupted 4-0 chromic suture. The skin was closed using subcuticular 4-0 Prolene suture.
Pathology:
Specimen: Neck, contents left neck level 4
A. Left neck level 4 contents, selective neck dissection: Three benign lymph nodes (0/3). Surrounding benign, mature fibroadipose tissue.
Neck mass
A. Neck
Received fresh designated contents left neck level 4 is a 4 x 2 x 1.5 cm fragment of adipose tissue containing a 2 x 1 cm node and 2 0.3 cm nodes. The large node is trisected and entirely submitted in A 1 and A2. 2 small nodes inked black and submitted whole in A 1.