How To Use CPT Code 38505

CPT 38505 is a code used for biopsy or excision of superficial lymph nodes using a needle, typically in the cervical, inguinal, or axillary areas. This article will cover the description, procedure, qualifying circumstances, when to use the code, documentation requirements, billing guidelines, historical information, similar codes, and examples of CPT 38505 procedures.

1. What is CPT 38505?

CPT 38505 is a medical code used to describe the procedure of biopsy or excision of superficial lymph nodes using a needle. This procedure is commonly performed to identify and diagnose the cause of disease in the lymph node or surrounding tissues. The lymph nodes that are typically targeted in this procedure are located in the cervical, inguinal, or axillary areas.

2. 38505 CPT code description

The official description of CPT code 38505 is: “Biopsy or excision of lymph node(s); by needle, superficial (eg, cervical, inguinal, axillary)”.

3. Procedure

1. The patient is appropriately prepped and anesthetized.
2. The provider incises the skin over the underlying lymph node, which is typically near the surface of the skin.
3. The provider identifies the target lymph node or nodes, which can be visualized or palpated without guidance. Radiologic guidance may be used if necessary.
4. The provider injects a local anesthetic and inserts a large needle into the node.
5. A sample is removed from the node, and multiple specimens may be taken from the same lymph node if needed.
6. The provider applies pressure to stop bleeding from the site and applies a bandage.

4. Qualifying circumstances

Patients who are eligible to receive CPT 38505 services are those who require a biopsy or excision of superficial lymph nodes for diagnostic purposes. This may include patients with suspected lymphoma, metastatic cancer, or other conditions affecting the lymphatic system. The provider must determine that a needle biopsy or excision is the most appropriate method for obtaining the necessary tissue sample.

5. When to use CPT code 38505

It is appropriate to bill the 38505 CPT code when a provider performs a biopsy or excision of superficial lymph nodes using a needle. This code should be used for procedures targeting lymph nodes in the cervical, inguinal, or axillary areas. The code should not be used for fine needle aspiration biopsy procedures, which have their own set of CPT codes.

6. Documentation requirements

To support a claim for CPT 38505, the following information should be documented in the patient’s medical record:

• Indication for the procedure, including the suspected diagnosis or condition affecting the lymph node(s).
• Details of the procedure, including the location of the targeted lymph node(s), the use of any guidance, and the number of specimens obtained.
• Any complications or adverse events that occurred during the procedure.
• Results of the biopsy or excision, including any pathological findings.

7. Billing guidelines

When billing for CPT code 38505, keep in mind the following guidelines and rules:

• Report 38505 only once, regardless of the number of specimens obtained from the same node or the number of nodes biopsied in the same area.
• If the provider performs biopsies in other areas, report the code again with modifier 59 (Distinct procedural service) to indicate that a different area was tested.
• Biopsies on the contralateral or opposite side may be coded with modifier 50 (Bilateral procedure).
• If imaging guidance is performed, report the guidance separately with the appropriate CPT code, provided that there is documentation of visualization of the target area and a permanent image is kept.

8. Historical information

CPT 38505 was added to the Current Procedural Terminology system on January 1, 1990. There have been no updates to the code since its addition.

9. Similar codes to CPT 38505

Five similar codes to CPT 38505 and how they differ are:

• CPT 10004-10012: These codes are used for fine needle aspiration biopsy procedures, which involve the use of a smaller needle to obtain a sample of cells from the lymph node.
• CPT 10021: This code is used for fine needle aspiration biopsy without imaging guidance, which is a different procedure than the needle biopsy or excision described by CPT 38505.
• CPT 88172-88173: These codes are used for the evaluation of fine needle aspirate, which is the analysis of the sample obtained during a fine needle aspiration biopsy procedure.
• CPT 76942, 77002, 77012, 77021: These codes are used for imaging guidance during needle biopsy or excision procedures, and should be reported separately if used in conjunction with CPT 38505.

10. Examples

1. A patient with a suspected lymphoma undergoes a needle biopsy of a cervical lymph node using CPT 38505.
2. A patient with metastatic breast cancer has a needle excision of an axillary lymph node for staging purposes using CPT 38505.
3. A patient with an enlarged inguinal lymph node of unknown etiology undergoes a needle biopsy using CPT 38505.
4. A patient with a history of melanoma has a needle biopsy of a cervical lymph node to evaluate for possible metastasis using CPT 38505.
5. A patient with suspected sarcoidosis undergoes a needle biopsy of an axillary lymph node for diagnostic purposes using CPT 38505.
6. A patient with a history of testicular cancer has a needle excision of an inguinal lymph node to assess for recurrence using CPT 38505.
7. A patient with a suspected infection in the cervical lymph nodes undergoes a needle biopsy using CPT 38505 to obtain a sample for culture and sensitivity testing.
8. A patient with a history of lung cancer has a needle biopsy of an axillary lymph node to evaluate for possible metastasis using CPT 38505.
9. A patient with an enlarged inguinal lymph node and a history of lymphoma undergoes a needle biopsy using CPT 38505 to assess for disease recurrence.
10. A patient with a suspected autoimmune disorder undergoes a needle biopsy of a cervical lymph node for diagnostic purposes using CPT 38505.