How To Use CPT Code 38530

CPT 38530 describes the procedure of an open excision or biopsy of lymph nodes in the internal mammary gland. This article will cover the official description, procedure, qualifying circumstances, appropriate usage, documentation requirements, billing guidelines, historical information and billing examples.

1. What is CPT Code 38530?

CPT 38530 can be used to describe the open excision or biopsy of lymph nodes in the internal mammary gland. This procedure is performed by a healthcare provider to identify and diagnose the cause of disease in the lymph node or surrounding tissues. It involves using a scalpel to remove the lymph node(s) in the internal mammary gland.

2. Official Description

The official description of CPT code 38530 is: ‘Biopsy or excision of lymph node(s); open, internal mammary node(s).’ This code should not be reported with codes 38720-38746 or 49180. For percutaneous needle biopsy of retroperitoneal lymph node or mass, use code 49180. For fine needle aspiration biopsy of retroperitoneal lymph node or mass, refer to codes 10005, 10006, 10007, 10008, 10009, 10010, 10011, or 10012.

3. Procedure

1. The healthcare provider prepares the patient for the procedure, ensuring they are appropriately prepped and anesthetized.
2. Using a scalpel, the provider makes an incision and dissects the tissue overlying the internal mammary node(s).
3. The provider carefully removes the lymph node(s), taking care to preserve critical nerves and structures in the area.
4. The tissues are reapproximated in layers, and a drain may be placed and sutured to the skin to facilitate drainage during the healing process.
5. The incision is closed with sutures.

4. Qualifying circumstances

CPT 38530 is performed on patients who require a biopsy or excision of lymph nodes in the internal mammary gland. The procedure is typically done to identify and diagnose the cause of disease in the lymph node or surrounding tissues. It is important to note that this code should not be reported with codes 38720-38746 or 49180.

5. When to use CPT code 38530

CPT code 38530 should be used when a healthcare provider performs an open excision or biopsy of lymph nodes in the internal mammary gland. It is appropriate to use this code when the procedure is performed, and it should not be reported with codes 38720-38746 or 49180.

6. Documentation requirements

To support a claim for CPT 38530, the healthcare provider must document the following information:

• Patient’s diagnosis and the need for the biopsy or excision
• Details of the procedure, including the use of a scalpel and the removal of lymph node(s) in the internal mammary gland
• Date of the procedure
• Any additional procedures performed or complications encountered
• Signature of the healthcare provider performing the procedure

7. Billing guidelines

When billing for CPT 38530, ensure that the procedure performed is an open excision or biopsy of lymph nodes in the internal mammary gland. Do not report this code with codes 38720-38746 or 49180. If the procedure is performed on different areas, modifier 59 may be used to indicate distinct procedural service. For biopsies performed on the contralateral or opposite side, modifier 50 should be used to indicate a bilateral procedure.

8. Historical information

CPT 38530 was added to the Current Procedural Terminology system on January 1, 1990. There have been no updates to the code since its addition.

9. Examples

1. A surgeon performs an open excision of lymph nodes in the internal mammary gland to diagnose the cause of disease in a patient.
2. A healthcare provider performs a biopsy of lymph nodes in the internal mammary gland to identify the presence of cancer.
3. A patient undergoes an excision of lymph nodes in the internal mammary gland to investigate the cause of persistent swelling in the area.
4. A surgeon performs a biopsy of lymph nodes in the internal mammary gland to determine the extent of disease in a patient with suspected lymphoma.
5. A healthcare provider performs an excision of lymph nodes in the internal mammary gland to investigate the cause of recurrent infections in a patient.
6. A patient undergoes a biopsy of lymph nodes in the internal mammary gland to rule out the presence of metastatic cancer.
7. A surgeon performs an excision of lymph nodes in the internal mammary gland to investigate the cause of unexplained pain in a patient.
8. A healthcare provider performs a biopsy of lymph nodes in the internal mammary gland to determine the cause of abnormal lymph node enlargement in a patient.
9. A patient undergoes an excision of lymph nodes in the internal mammary gland to investigate the cause of unexplained weight loss.
10. A surgeon performs a biopsy of lymph nodes in the internal mammary gland to evaluate the response to treatment in a patient with known cancer.