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The procedure described by CPT® Code 38550 involves the excision of a cystic hygroma located in the axillary or cervical region, specifically without the need for deep neurovascular dissection. A cystic hygroma, also known as a cystic lymphangioma, is characterized by the presence of one or more cysts filled with lymphatic fluid, which results from a blockage in the lymphatic system. These cysts can be congenital, meaning they are present at birth, or they may develop later in life. The excision process begins with an incision through the skin and subcutaneous tissue that covers the cystic hygroma. In cases where the cyst is situated in the axilla, the surgeon will carefully open deeper tissues to expose the cystic mass, ensuring that surrounding nerves and blood vessels are preserved during dissection. If the cystic hygroma is located in the neck, the procedure involves incising the platysma muscle and creating subplatysmal flaps. The depth of the cystic mass may necessitate further dissection of deeper tissues, which is performed with caution to protect the carotid sheath that houses critical structures such as the carotid artery, internal jugular vein, and vagus nerve. The dissection continues until the cystic sac is completely separated from the surrounding tissues, allowing for its removal. In instances where multiple cystic sacs are present, each sac is meticulously dissected and excised. This procedure is specifically coded as 38550 when deep neurovascular dissection is not required, while 38555 is used when such dissection is necessary.
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The excision of a cystic hygroma is indicated for the following conditions:
The procedure for excising a cystic hygroma involves several detailed steps:
After the excision of a cystic hygroma, post-procedure care typically includes monitoring the surgical site for signs of infection, managing pain, and ensuring proper wound healing. Patients may be advised to keep the area clean and dry, and follow-up appointments are often scheduled to assess recovery and address any complications. The expected recovery time may vary depending on the extent of the procedure and the individual patient's health status. It is important for patients to adhere to their surgeon's post-operative instructions to facilitate optimal healing.
| Short Descr | REMOVAL NECK/ARMPIT LESION | Medium Descr | EXC CSTIC HYGROMA AX/CRV W/O DP NEUROVASC DSJ | Long Descr | Excision of cystic hygroma, axillary or cervical; without deep neurovascular dissection | 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) | 0 - 150% payment adjustment for bilateral procedures does NOT apply. | Physician Supervisions | 09 - Concept does not apply. | Assistant Surgeon (80, 82) | 0 - 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 |
| 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). | 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. | AS | Physician assistant, nurse practitioner, or clinical nurse specialist services for assistant at surgery | CC | Procedure code change (use 'cc' when the procedure code submitted was changed either for administrative reasons or because an incorrect code was filed) | GC | This service has been performed in part by a resident under the direction of a teaching physician | LT | Left side (used to identify procedures performed on the left side of the body) | Q1 | Routine clinical service provided in a clinical research study that is in an approved clinical research study | RT | Right side (used to identify procedures performed on the right side of the body) | 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. |
| Pre-1990 | Added | Code added. |
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