Wiki 52 Reduced Services Mod on Neck Dissections

[dmejia1220]

I am a Head & Neck coder & I have a concern I need some help with.

I was told that when you bill for a Cervical Lymphadenectomy Complete
(38720) or an Cervical Lymphadenectomy (Modified radical Neck Dissection) (38724) & the surgeon does not remove all of the levels of lymph nodes described in the procedure, that a 52 Reduced Services modifier needs to be appended to the case. Can anyone with experience in this procedure confirm that for me?

Any help would be greatly appreciated. Thank You.

 

[jackjones62]

I don't agree, coding is neither black or white, but gray....everything is subjective, with neck dissections you have approximately 3 codes to work with,
CPT 38700 - Suprahyoid Lymphadenectomy, a limited neck dissection that usually includes level 1 & 2; CPT 38720 - Cervical Lymphadenectomy (Complete), covers it all, it's a radical dissection that basically cleans out everything; CPT 38724 - Cervical Lymphadenectomy (Modified Radical Neck Dissection) is a preservation approach where the surgeon preserves more tissue and structures, the "usual" components may or may not be removed with this code; so in terms of the use of Modifier 52, there should be no need.

Jennifer
CT ENT

 

[dmejia1220]

Thank you for the response, very helpful.

Dennis

 

[elsaee87]

I don't agree, coding is neither black or white, but gray....everything is subjective, with neck dissections you have approximately 3 codes to work with,
CPT 38700 - Suprahyoid Lymphadenectomy, a limited neck dissection that usually includes level 1 & 2; CPT 38720 - Cervical Lymphadenectomy (Complete), covers it all, it's a radical dissection that basically cleans out everything; CPT 38724 - Cervical Lymphadenectomy (Modified Radical Neck Dissection) is a preservation approach where the surgeon preserves more tissue and structures, the "usual" components may or may not be removed with this code; so in terms of the use of Modifier 52, there should be no need.

Jennifer
CT ENT

If that were true, then in which cases WOULD you use a modifier 52 on 38724? When its only a few lymph nodes from one or two levels (I-V)? A paratracheal dissection only?

CPT Assistant, August 2010 Page: 3-7, 15
•Modified Radical Neck Dissection (MRND): Removal of all lymph node groups routinely removed in an RND, but with preservation of one or more non-lymphatic structures (SAN, SCM, and IJV). MRND is reported with CPT code 38724, Cervical lymphadenectomy (modified radical neck dissection). Modifications to the radical neck dissection include the following:

•Type I: The spinal accessory nerve is preserved.

•Type II: The spinal accessory nerve and the internal jugular vein are preserved.

•Type III: The spinal accessory nerve, the internal jugular vein, and the sternocleidomastoid muscle are preserved.

• Both the RND and MRND procedures are comprehensive dissections of neck levels I-V