Otolaryngology Coding Alert

"Neck dissections are difficult to code because they often are associated with a primary procedure to remove malignancy elsewhere. In some cases, these primary procedures already include radical neck dissections (RND). With other procedures, RNDs are not included and may be billed separately.

There are two main types of neck dissections radical and modified radical and different coding guidelines apply to each. When a neck dissection is performed on both sides during the same session as a primary procedure (such as laryngectomy, glossectomy, or parotidectomy), coders may need to use modifiers to indicate to the carrier that the dissection is not bundled with the primary procedure and should be paid separately.

Neck dissections are performed when malignancy is detected in the lymph nodes of the neck and associated areas. The malignancy may be primary (originating in the lymphatic system) or more often secondary (resulting from a primary malignancy elsewhere).

How to Code Lymphadenectomies

Neck dissections also are referred to as cervical lymphadenectomies. These procedures, when they are performed on their own, involve removal of the lymph node chain from the neck and are coded as follows:

38720 cervical lymphadenectomy (complete)
38724 cervical lymphadenectomy (modified radical neck dissection)

Code 38720 is used when a radical neck dissection is performed. In this procedure, lymphatic tissue, the jugular vein, the spinal accessory nerve and the sternocleidomastoid muscles are sacrificed to remove the cancerous lymphatic chain.

A radical neck dissection is performed when necessary, but because it is associated with high morbidity, otolaryngologists perform modified radical neck dissections whenever possible. In this procedure, the lymphatic chain is removed but the spinal accessory nerve, jugular vein and sternocleidomastoid muscles are preserved. Because this procedure is more meticulous, and hence more complex, it is reimbursed at a higher rate (38720 is assigned 30.18 relative value units [RVUs], whereas 38724 has 31.05 RVUs).

Note: Suprahyoid lymphadenectomy (38700), which is performed to remove lesions near the floor of the mouth, is included in both 38720 and 38724 and should not be billed separately if performed during the same session.

Clarity Lies in the Operative Report

To code neck dissections and their associated primary procedures correctly, coders need to be able to distinguish between a radical neck dissection and a modified radical neck dissection, says Margaret Hickey, MS, MSN, RN, OCN, CORLN, an otolaryngology coding consultant in New Orleans and past-president of the Society of Otorhinolaryngology and Head-Neck Nurses.

The key is to read the operative report, says Hickey. The otolaryngologist may describe the [...]