Otolaryngology Coding Alert

Answer: The lymph nodes in the jaw and face area are superficial to (and occasionally embedded in) the parotid gland, and their removal should be coded 38500 (biopsy or excision of lymph node[s]; superficial [separate procedure]), even when they have to be dissected out of the gland, says Eric Sandham, CPC, compliance educator with Central California Faculty Medical Group in Fresno.

If the approach begins from underneath the mandible (jawbone) and involves limited upper cervical (neck) dissection, it could represent a deep cervical lymph node excision (38510) or suprahyoid lymphadenectomy (38700), Sandham says. He adds that jugular lymph nodes are located adjacent to the sternocleidomastoid muscles (the large muscles that go up either side of the neck), and their removal would be coded 38542 (dissection, deep jugular node[s])