Coding, Classification and Reimbursement

Excisional biopsy of enlarged lymph node - neck

  • 1.  Excisional biopsy of enlarged lymph node - neck

    Posted 16 days ago
    Physician performs excisional biopsy of enlarged lymph node measuring 5.1 cm on the left side of the neck. Physician wants to report 21554 (excision, tumor, soft tissue of neck or anterior thorax, subfascial, greater than 5 cm).

    Is it really appropriate to code an enlarged lymph node as a "tumor"? His description in the report never refers to a tumor. I think it should be coded as 38510 (biopsy or excision of lymph node(s); open, deep cervical node(s) ).

    The RVU's are less in 38510 so I don't want to shortchange my physician if there is anything I've not considered to justify using 21554.

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    Ryan Stroup
    Biller/Coder, ENT
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  • 2.  RE: Excisional biopsy of enlarged lymph node - neck

    Posted 16 days ago

    If the physician excised a cervical lymph node, I would assign the lymph node code (38500 or 38510 .  The cervical lymph node codes are based on depth as you are already aware of.



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    Cristina Co
    Facility Outpatient Coder
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  • 3.  RE: Excisional biopsy of enlarged lymph node - neck

    Posted 15 days ago
    Hi Cristina,

    Thanks for your input. You are correct, the depth and type of lymph node are not in question based on his report. My concern is coding an excisional biopsy of an enlarged lymph node as a tumor excision.

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    Ryan Stroup
    Biller/Coder, ENT
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  • 4.  RE: Excisional biopsy of enlarged lymph node - neck

    Posted 14 days ago
    Edited by Bianca Leal 14 days ago
    i see your point.
    Per supercoder for 21554

    Clinical Responsibility

    The physician makes a longitudinal incision over the tumor and dissects into the muscle where the tumor lies. He identifies the mass and dissects it off the muscles to which it is attached, ligating and incising any feeding vessels or arteries and protecting any nerves. He then irrigates the wound and places a drain, then closes the incision in layers.

    38510

    Clinical Responsibility

    When the patient is appropriately prepped and anesthetized, the provider adjusts the neck of the patient to improve access to the target area. The provider uses a scalpel to incise the skin and dissect the tissue overlying the target node or nodes, taking care to preserve critical nerves and other structures in the area. The provider then excises the lymph node or nodes and approximates the tissues in layers. The provider may place a drain and suture it to the skin to drain blood or other fluids while the wound heals. Finally, he closes the incision with sutures.



    If the Provider didn't dissect a tumor and just an excision of a enlarge lymph node 38510 would be appropriate.



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    Bianca Leal, CCS
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