Otolaryngology Coding Alert

Question: I just purchased your audioconference CD "Decipher Neck Dissection Vocabulary and Unlock the Correct Codes" and remain quite interested in how you resolved the after conference question, how do you code a central neck dissection? Since this anterior neck dissection targets only level VI lymph nodes, it would seem an exception to both RND and MRND as they include Lymph Nodes II- V.

I've read this to be a modification of a selective neck dissection, but no MRND involves these level VI nodes (a quite arduous and distinct dissection). I find a previous recommendation of using 38724-52 unsatisfactory for this very reason. What should I report?

Massachusetts Subscriber

Answer: The most accurate code for this is 38999 (Unlisted procedure,hemic or lymphatic system). Central compartment neck dissection refers to the bilateral removal of lymph nodes surrounding the midline visceral structures of the anterior neck. The lymph nodes include the pre- and paratracheal, precricoid and perithyroidal. The upper limit of the dissection is the hyoid bone; the lower limit is the suprasternal notch; and the lateral limits are the carotid arteries.

Unlisted procedure codes do not appear in the Medicare Physician Fee Schedule, so they do not have assigned fees or global periods. Your payers will generally determine payment for unlisted-procedure claims based on the documentation you provide. You can suggest a fee by comparing the unlisted procedure to a similar, listed procedure with an established reimbursement value. It helps put your service in perspective with something they are familiar with, experts say. Therefore, for your fee, compare this code to 38724 (Cervical lymphadenectomy [modified radical neck dissection]).

Remember: Any time you file a claim using an unlistedprocedure code, you should include a cover letter stating why you are using the unlisted code. This separate report should explain, in simple, straightforward language, exactly what the physician did.

Correction: This corrects the advice presented in the Otolaryngology Coding Alert, 2010, Vol. 12, no. 3's  Reader Question entitled "Reduce Services on 38724 for Central Neck." You should not go for 38724 with modifier 52 (Reduced services). Use the unlisted code instead.