How To Use CPT Code 38520

CPT 38520 describes the excision of lymph nodes in the deep tissues of the neck and the scalene fat pad through an open incision. This article will cover the description, procedure, qualifying circumstances, appropriate usage, documentation requirements, billing guidelines, historical information and billing examples.

1. What is CPT Code 38520?

CPT 38520 can be used to describe the surgical removal of lymph nodes in the deep tissues of the neck and the scalene fat pad. This procedure is performed through an open incision and may be done as an investigation or treatment of tumors in the neck or chest.

2. Official Description

The official description of CPT code 38520 is: ‘Biopsy or excision of lymph node(s); open, deep cervical node(s) with excision scalene fat pad.’

3. Procedure

1. The provider positions the patient supine with the neck extended and turned to the opposite side to improve access to the target area.
2. A 10 cm incision is made in the front of the neck, just 2 cm above the collarbone.
3. The provider cuts through the sternocleidomastoid muscle, the oblique prominent muscle in front of the neck.
4. The platysma and omohyoid muscles are retracted to gain a view of the lymph nodes to be excised.
5. The tissue overlying the target node or nodes is separated, taking care to preserve critical structures like the phrenic nerve and the thoracic duct.
6. The provider excises the lymph node or nodes and dissects out the scalene fat pad.
7. If necessary, the excised lymph nodes may be sent for biopsy.
8. After controlling bleeding, a drain is placed and the wound is closed in layers.

4. Qualifying circumstances

CPT 38520 is used for the excision of lymph nodes in the deep tissues of the neck and the scalene fat pad. This procedure is typically performed as an investigation or treatment of tumors in the neck or chest. It may be used when lymph nodes are identified as possibly diseased and need to be removed for further analysis. The code can be used for any deep node in the neck, and it is important to preserve critical structures during the excision.

5. When to use CPT code 38520

CPT code 38520 should be used when the provider performs the excision of lymph nodes in the deep tissues of the neck and the scalene fat pad through an open incision. It is appropriate for cases where lymph nodes are identified as possibly diseased and need to be removed for further analysis or as part of the treatment for tumors in the neck or chest.

6. Documentation requirements

To support a claim for CPT 38520, the provider must document the following information:

• Reason for the excision of lymph nodes
• Details of the procedure, including the incision site and the structures preserved
• Any additional procedures performed, such as biopsy
• Any complications or unexpected findings
• Post-operative care instructions

7. Billing guidelines

When billing for CPT 38520, ensure that the excision of lymph nodes in the deep tissues of the neck and the scalene fat pad is performed through an open incision. Use modifier 50 if the procedure is performed on the opposite side. It is important to follow the specific guidelines provided by the payer to ensure accurate and appropriate billing.

8. Historical information

CPT 38520 was added to the Current Procedural Terminology system on January 1, 1990. The code underwent a change on January 1, 2001, with the addition of the term “deep” to the description.

9. Examples

1. A provider performs an excision of lymph nodes in the deep tissues of the neck and the scalene fat pad through an open incision to investigate a tumor in the neck.
2. A patient undergoes an excision of lymph nodes in the deep tissues of the neck and the scalene fat pad through an open incision as part of the treatment for a chest tumor.
3. A provider performs an excision of lymph nodes in the deep tissues of the neck and the scalene fat pad through an open incision to remove possibly diseased lymph nodes for further analysis.
4. A patient undergoes an excision of lymph nodes in the deep tissues of the neck and the scalene fat pad through an open incision to investigate the spread of cancer in the neck.
5. A provider performs an excision of lymph nodes in the deep tissues of the neck and the scalene fat pad through an open incision to treat extensive disease in the neck.
6. A patient undergoes an excision of lymph nodes in the deep tissues of the neck and the scalene fat pad through an open incision to remove lymph nodes affected by an infection.
7. A provider performs an excision of lymph nodes in the deep tissues of the neck and the scalene fat pad through an open incision to investigate the cause of swollen lymph nodes in the neck.
8. A patient undergoes an excision of lymph nodes in the deep tissues of the neck and the scalene fat pad through an open incision to remove lymph nodes affected by a benign tumor.
9. A provider performs an excision of lymph nodes in the deep tissues of the neck and the scalene fat pad through an open incision to investigate the spread of cancer from the chest to the neck.