Hi there!!
We are having a discussion on whether or not we can unbundle the lymph nodes from a parotidectomy - In Paget's it seems to be a grey area with the wording of "Very often a salivary gland comes in with a major resection, and one or more dissimilar tissues are present for diagnosis as well; the dissimilar tissues almost invariably are separately chargeable" - some of us feel we can unbundle while others feel that Parotid glands essentially always have lymph nodes interspersed throughout and adjacent to the salivary parenchyma (it is a normal part of the gland) so we shouldn't - I'm using this case below as an example - anyone have thoughts on this?
Right parotid tail with mass, partial parotidectomy:
- Warthin tumor (6 cm).
- Uninvolved parotid parenchyma with no significant pathologic abnormality.
- 3 benign intra-/periparotid lymph nodes.
We are having a discussion on whether or not we can unbundle the lymph nodes from a parotidectomy - In Paget's it seems to be a grey area with the wording of "Very often a salivary gland comes in with a major resection, and one or more dissimilar tissues are present for diagnosis as well; the dissimilar tissues almost invariably are separately chargeable" - some of us feel we can unbundle while others feel that Parotid glands essentially always have lymph nodes interspersed throughout and adjacent to the salivary parenchyma (it is a normal part of the gland) so we shouldn't - I'm using this case below as an example - anyone have thoughts on this?
Right parotid tail with mass, partial parotidectomy:
- Warthin tumor (6 cm).
- Uninvolved parotid parenchyma with no significant pathologic abnormality.
- 3 benign intra-/periparotid lymph nodes.