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The procedure described by CPT® Code 38520 involves an open biopsy or excision of deep cervical lymph nodes, specifically targeting those located within the deep cervical region of the neck. Deep cervical lymph nodes are critical components of the lymphatic system and include various chains such as the spinal accessory chain, transverse cervical chain, and the Delphian node. During this procedure, a surgical incision is made in the skin over the affected lymph nodes, allowing access to the underlying structures. The platysma muscle, which is a thin layer of muscle in the neck, is incised to facilitate deeper dissection. Surgeons carefully navigate through the soft tissues, ensuring the protection of surrounding nerves and blood vessels to minimize complications. Once the lymph nodes are adequately exposed, one or more nodes are dissected free from their surrounding tissues for removal or to obtain tissue samples for further analysis. Additionally, the procedure may involve the biopsy or excision of lymph nodes located within the scalene fat pad, which is situated beneath the inferior aspect of the scalene muscle and contains a small number of lymph nodes. To access this area, a supraclavicular skin incision is made, and the dissection continues through the platysma muscle. The sternocleidomastoid muscle is then divided near its attachment to the clavicle, allowing for the exposure of the scalene fat pad. The scalene fat pad is meticulously dissected from surrounding tissues and removed in its entirety. All excised lymph nodes, tissue samples, and the scalene fat pad are subsequently sent to the laboratory for histological evaluation, which is essential for diagnosing any underlying conditions. It is important to note that CPT® Code 38510 should be used when a deep cervical lymph node biopsy or excision is performed without the excision of the scalene fat pad, while CPT® Code 38520 is specifically designated for cases where scalene fat pad excision is included in the procedure.
© Copyright 2025 Coding Ahead. All rights reserved.
The procedure described by CPT® Code 38520 is indicated for various clinical scenarios involving deep cervical lymph nodes. These indications may include:
The procedure for CPT® Code 38520 involves several critical steps to ensure the successful biopsy or excision of deep cervical lymph nodes and the scalene fat pad. The steps are as follows:
After the completion of the procedure, patients may require specific post-operative care to ensure proper recovery. This may include monitoring for any signs of infection at the incision site, managing pain with appropriate analgesics, and following up with the healthcare provider for results from the histological evaluation. Patients are typically advised to avoid strenuous activities for a specified period to allow for healing. Additionally, any drainage tubes placed during the procedure may need to be monitored and managed according to the surgeon's instructions. Follow-up appointments are essential to discuss the results of the biopsy or excision and to determine any further treatment plans based on the findings.
| Short Descr | BIOPSY/REMOVAL LYMPH NODES | Medium Descr | BX/EXC LYMPH NODE OPN DP CRV NODE W/EXC FAT PAD | Long Descr | Biopsy or excision of lymph node(s); open, deep cervical node(s) with excision scalene fat pad | Status Code | Active Code | Global Days | 090 - Major Surgery | PC/TC Indicator (26, TC) | 0 - Physician Service Code | Multiple Procedures (51) | 2 - Standard payment adjustment rules for multiple procedures apply. | Bilateral Surgery (50) | 1 - 150% payment adjustment for bilateral procedures applies. | Physician Supervisions | 09 - Concept does not apply. | Assistant Surgeon (80, 82) | 1 - Statutory payment restriction for assistants at surgery applies to this procedure... | Co-Surgeons (62) | 0 - Co-surgeons not permitted for this procedure. | Team Surgery (66) | 0 - Team surgeons not permitted for this procedure. | Diagnostic Imaging Family | 99 - Concept Does Not Apply | APC Status Indicator | Hospital Part B services paid through a comprehensive APC | ASC Payment Indicator | Surgical procedure on ASC list in CY 2007; payment based on OPPS relative payment weight. | Type of Service (TOS) | 2 - Surgery | Berenson-Eggers TOS (BETOS) | P5E - Ambulatory procedures - other | MUE | 1 | CCS Clinical Classification | 67 - Other therapeutic procedures, hemic and lymphatic system |
This is a primary code that can be used with these additional add-on codes.
| 38900 | Addon Code MPFS Status: Active Code APC N ASC N1 Intraoperative identification (eg, mapping) of sentinel lymph node(s) includes injection of non-radioactive dye, when performed (List separately in addition to code for primary procedure) |
| 22 | Increased procedural services: when the work required to provide a service is substantially greater than typically required, it may be identified by adding modifier 22 to the usual procedure code. documentation must support the substantial additional work and the reason for the additional work (ie, increased intensity, time, technical difficulty of procedure, severity of patient's condition, physical and mental effort required). note: this modifier should not be appended to an e/m service. | 50 | Bilateral procedure: unless otherwise identified in the listings, bilateral procedures that are performed at the same session, should be identified by adding modifier 50 to the appropriate 5 digit code. note: this modifier should not be appended to designated "add-on" codes (see appendix d). | 51 | Multiple procedures: when multiple procedures, other than e/m services, physical medicine and rehabilitation services or provision of supplies (eg, vaccines), are performed at the same session by the same individual, the primary procedure or service may be reported as listed. the additional procedure(s) or service(s) may be identified by appending modifier 51 to the additional procedure or service code(s). note: this modifier should not be appended to designated "add-on" codes (see appendix d). | 58 | Staged or related procedure or service by the same physician or other qualified health care professional during the postoperative period: it may be necessary to indicate that the performance of a procedure or service during the postoperative period was: (a) planned or anticipated (staged); (b) more extensive than the original procedure; or (c) for therapy following a surgical procedure. this circumstance may be reported by adding modifier 58 to the staged or related procedure. note: for treatment of a problem that requires a return to the operating/procedure room (eg, unanticipated clinical condition), see modifier 78. | 59 | Distinct procedural service: under certain circumstances, it may be necessary to indicate that a procedure or service was distinct or independent from other non-e/m services performed on the same day. modifier 59 is used to identify procedures/services, other than e/m services, that are not normally reported together, but are appropriate under the circumstances. documentation must support a different session, different procedure or surgery, different site or organ system, separate incision/excision, separate lesion, or separate injury (or area of injury in extensive injuries) not ordinarily encountered or performed on the same day by the same individual. however, when another already established modifier is appropriate it should be used rather than modifier 59. only if no more descriptive modifier is available, and the use of modifier 59 best explains the circumstances, should modifier 59 be used. note: modifier 59 should not be appended to an e/m service. to report a separate and distinct e/m service with a non-e/m service performed on the same date, see modifier 25. | 78 | Unplanned return to the operating/procedure room by the same physician or other qualified health care professional following initial procedure for a related procedure during the postoperative period: it may be necessary to indicate that another procedure was performed during the postoperative period of the initial procedure (unplanned procedure following initial procedure). when this procedure is related to the first, and requires the use of an operating/procedure room, it may be reported by adding modifier 78 to the related procedure. (for repeat procedures, see modifier 76.) | 79 | Unrelated procedure or service by the same physician or other qualified health care professional during the postoperative period: the individual may need to indicate that the performance of a procedure or service during the postoperative period was unrelated to the original procedure. this circumstance may be reported by using modifier 79. (for repeat procedures on the same day, see modifier 76.) | 80 | Assistant surgeon: surgical assistant services may be identified by adding modifier 80 to the usual procedure number(s). | AS | Physician assistant, nurse practitioner, or clinical nurse specialist services for assistant at surgery | GC | This service has been performed in part by a resident under the direction of a teaching physician | GW | Service not related to the hospice patient's terminal condition | LT | Left side (used to identify procedures performed on the left side of the body) | RT | Right side (used to identify procedures performed on the right side of the body) | X4 | Episodic/focused services: for reporting services by clinicians who provide focused care on particular types of treatment limited to a defined period and circumstance; the patient has a problem, acute or chronic, that will be treated with surgery, radiation, or some other type of generally time-limited intervention; reporting clinician service examples include but are not limited to, the orthopedic surgeon performing a knee replacement and seeing the patient through the postoperative period | XS | Separate structure, a service that is distinct because it was performed on a separate organ/structure |
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| 2011-01-01 | Changed | Short description changed. |
| 2001-01-01 | Changed | Code description changed. |
| Pre-1990 | Added | Code added. |