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General Surgery Coding Alert

Reader Question:
Preserving Structures Governs Neck Code Choice

Question: Our surgeon performed an open selective neck dissection, removing cervical lymph nodes while preserving the internal jugular vein, spinal accessory nerve, and sternocleidomastoid muscle. Should we report this as 38510, 38724, or some other code?New Jersey SubscriberAnswer: The best choice for the procedure you describe is 38724 (Cervical lymphadenectomy [modified radical neck dissection]). Because the physician modifies the surgical dissection plane to preserve some or all of those critical structures mentioned in the report, the work clearly warrants a dissection code rather than a biopsy code.Don't code biopsy: A selective neck dissection represents a lymphadenectomy of the cervical nodes, not a biopsy. A biopsy involves removing one or a few lymph nodes -- from the cervical region for purposes of this discussion. For an open biopsy, you would choose one of the following codes depending on whether the nodes are superficial (not far below the skin) or deep:38500 -- Biopsy or [...]

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