What does it mean to have a neck dissection?
Foundation: Seeing notes about a neck dissection means that your surgeon removed some (or all) of the patient’s lymph nodes in the neck, plus possibly removed some other structures. A “neck dissection” is another way of saying that a “lymphadenectomy” was performed. CPT® includes three procedure codes for neck dissection:
What is the code for radical neck dissection?
“Your only choice is to bill the lower RVU bundled code (31365 or 41145) that describes the less difficult service (radical neck dissection) that was not performed, where a more difficult service (ie: the modified radical neck dissection) was performed,” Cobuzzi says.
What is a 38720 neck dissection?
A complete, or radical, neck dissection (38720) involves removal of all lymph nodes from levels 1 through 5 of the neck along with removal of the sternocleidomastoid muscle, the spinal accessory nerve, and the jugular vein. These procedures are known as “radical” because the surgeon removes many structures.
What is a level 6 neck dissection?
Level VI neck dissection and central neck dissection are interchangeable terms used to describe surgical excision of all lymph nodes from the hyoid bone to the carotid arteries’ sternal notch, but the superior mediastinal lymph nodes added in compartment VII should be included in the central neck.
What is the CPT code for neck dissection?
CPT® includes three procedure codes for neck dissection: 38720 – Cervical lymphadenectomy (complete) 38724 – Cervical lymphadenectomy (modified radical neck dissection) (also referred to as a “MRND”) 38700 – Suprahyoid lymphadenectomy.
What is a central neck dissection?
An ipsilateral central neck dissection involves removal of nodes on the same side as the thyroid cancer, whereas a bilateral CLND would include resection of all lymph nodes found in this central compartment.
What are the three types of neck dissection?
Neck dissection is a major surgery done to remove lymph nodes that contain cancer....There are 3 main types of neck dissection surgery:Radical neck dissection. ... Modified radical neck dissection. ... Selective neck dissection.
What does CPT code 38900 mean?
38900, 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)
What is the CPT code for total thyroidectomy with central neck dissection?
So, if it is stated that a central neck dissection is performed with a total thyroidectomy, you would report 60252 (Thyroidectomy, total or subtotal for malignancy; with limited neck dissection).
How many lymph nodes are removed in a central neck dissection?
The term CND, as defined by the ATA consensus, implies removal of prelaryngeal and pretracheal lymphatic tissue and at least one paratracheal lymph node. This is defined as unilateral CND, whereas in bilateral CND paratracheal nodes on both sides are removed (5,6).
What is the difference between a modified radical neck dissection and a radical neck dissection?
Modified radical neck dissection involves removal of cervical nodes, levels I through V, as in classical radical neck dissection, but with preservation of one or more of the key extranodal structures (spinal accessory nerve, sternocleidomastoid muscle, and internal jugular vein).
What is a Level 1 neck dissection?
Dissection. Submandibular and submental dissection (Level I) If perifacial lymph nodes do not require removal, the superior skin flap is raised to the inferior aspect of the submandibular gland. The fascia over the gland is incised, and the posterior facial vein is ligated and divided. Both are elevated off the gland.
What is modified neck dissection?
Modified radical neck dissection (MRND) is defined as the excision of all lymph nodes routinely removed in a radical neck dissection with preservation of one or more nonlymphatic structures (SAN, IJV, SCM).
What is the difference between 38792 and 38900?
38792 is for the radioactive tracer that is usually injected in a different locale before surgery. The 38900 is the methylene blue that the surgeon injects during surgery and it is not radioactive. These are usually both used for a SLN biopsy/excision.
What does CPT 19301 include?
Report the following codes: 19301, Mastectomy, partial (eg, lumpectomy, tylectomy, quadrantectomy, segmentectomy); 38525, Biopsy or excision of lymph node(s); open, deep axillary node(s); +38900, Intraoperative identification (eg, mapping) of sentinel lymph node(s) includes injection of non-radioactive dye, when ...
What CPT code is 36561?
The Current Procedural Terminology (CPT®) code 36561 as maintained by American Medical Association, is a medical procedural code under the range - Insertion of Central Venous Access Device.
How long is recovery from neck dissection?
Avoid straining your neck muscles or lifting objects weighing more than 10 pounds (lbs) or 4.5 kilograms (kg) for 4 to 6 weeks. Try to walk every day. You can return to sports (golf, tennis, and running) after 4 to 6 weeks. Most people are able to go back to work in 2 to 3 weeks.
What are the side effects of a neck dissection?
A neck dissection has some common side effects, including:Ear numbness.Swallowing problems.Weakness when raising your arm above your head.Weakness in your lower lip.Wound healing problems.
How long does a neck dissection surgery take?
The area for surgery is often marked to make sure there are no errors. You will be kept comfortable and safe by your anesthesia provider. You will be asleep during the surgery. The surgery will take about 2 to 4 hours.
Is a neck dissection painful?
Conclusions: Chronic pain localized to the operative site is an uncommon occurrence even after radical neck dissection. Chronic pain in the shoulder region may follow radical neck dissection, whereas modified neck dissection is usually a painless procedure.
What is the CPT code for cervical lymphadenectomy?
As a result of the advocacy of the Academy, the National Correct Coding Initiative (NCCI) will delete the current bundling edit for the neck dissection CPT codes (387 20- Cervical lymphadenectomy (complete) and 38724 – Cervical lymphadenectomy (modified radical neck dissection) when performed on the same patient and the same date of service with CPT code 31525 – Laryngoscopy direct, with or without tracheoscopy; for aspiration;diagnostic, except newborn. The NCCI will implement this change in version 15.2 on July 1, 2009. Previously, physicians who performed both procedures on the same date could override the bundling edit by using a relevant modifier.
What is CPT for ENT?
CPT for ENT articles are a collaborative effort between the Academy’s team of CPT Advisors, members of the Physician Payment Policy (3P) workgroup, and health policy staff. Articles are developed to address common coding questions received by the health policy team, as well as to clarify coding changes and correct coding principles for frequently reported ENT procedures. These articles are not intended as legal, medical, or business advice and are not a guarantee of reimbursement. The information is also not meant to serve as the definitive or sole authority on billing and coding issues. The applicability of AAO-HNS billing and coding guidance for a particular procedure, must be determined by the responsible physician in light of all the circumstances presented by the individual patient. You should consult with your own advisors as well as Medicare or private carriers in making any decisions about how to bill and code particular services or procedures.
Can you have neck dissection and laryngoscopy on the same day?
The same surgeon may perform both services on the same date but, more frequently, they would not. You will want to provide clear documentation explaining the medical necessity of performing the neck dissection and laryngoscopy on the same date.
What is the CPT code for cervical lymphadenectomy?from entnet.org
As a result of the advocacy of the Academy, the National Correct Coding Initiative (NCCI) will delete the current bundling edit for the neck dissection CPT codes (387 20- Cervical lymphadenectomy (complete) and 38724 – Cervical lymphadenectomy (modified radical neck dissection) when performed on the same patient and the same date of service with CPT code 31525 – Laryngoscopy direct, with or without tracheoscopy; for aspiration;diagnostic, except newborn. The NCCI will implement this change in version 15.2 on July 1, 2009. Previously, physicians who performed both procedures on the same date could override the bundling edit by using a relevant modifier.
What is CPT for ENT?from entnet.org
CPT for ENT articles are a collaborative effort between the Academy’s team of CPT Advisors, members of the Physician Payment Policy (3P) workgroup, and health policy staff. Articles are developed to address common coding questions received by the health policy team, as well as to clarify coding changes and correct coding principles for frequently reported ENT procedures. These articles are not intended as legal, medical, or business advice and are not a guarantee of reimbursement. The information is also not meant to serve as the definitive or sole authority on billing and coding issues. The applicability of AAO-HNS billing and coding guidance for a particular procedure, must be determined by the responsible physician in light of all the circumstances presented by the individual patient. You should consult with your own advisors as well as Medicare or private carriers in making any decisions about how to bill and code particular services or procedures.
Can you have neck dissection and laryngoscopy on the same day?from entnet.org
The same surgeon may perform both services on the same date but, more frequently, they would not. You will want to provide clear documentation explaining the medical necessity of performing the neck dissection and laryngoscopy on the same date.
What is neck dissection?
Neck dissection refers to the removal of lymph nodes and surrounding tissue from the neck for the purpose of cancer treatment. The extent of tissue removal depends on many factors including, the stage of disease which reflects the extent of cancer as well as the type of cancer. The most common cancers removed from lymph nodes in ...
How is neck dissection done?
Neck dissections are done under general anesthesia through an incision that runs along a skin crease in the neck, extending vertically on the side of the neck. Incisions are usually designed to enhance the visualization and protection of important structures in the neck, and enable the safe removal of lymph nodes that harbor cancer.
What is a Neck Dissection and Why is it Performed?
Neck dissection is usually performed to remove cancer that has spread to lymph nodes in the neck.
What is the term for the removal of lymph nodes?
When someone undergoes surgery for cancer that has spread to lymph nodes, both the initial or primary cancer as well as the metastases must be removed. Neck dissection refers to the removal of lymph nodes and surrounding tissue from the neck for the purpose of cancer treatment.
Why is radical neck dissection important?
The radical neck dissection was designed to ensure complete cancer removal in individuals with very advanced cancers in the neck. The radical neck dissection is effective but produces characteristic cosmetic changes. Because so much tissue is removed, one side of the neck may appear flatter than the other. More importantly, sacrifice of the nerve ...
How many lymph nodes are there on each side of the neck?
There are over 150 lymph nodes on each side of the neck. During an operation, a surgeon will not be able to tell if a lymph node is clean, or if it has cancer that will later grow into a visible neck lump. The lymph nodes must be processed and tested; this takes time.
Why is one side of my neck flatter than the other?
Because so much tissue is removed , one side of the neck may appear flatter than the other. More importantly, sacrifice of the nerve to the trapezius muscle results in visible drooping of the shoulder and difficulty in raising the arm over head. Some individuals develop pain in the neck and collarbone.
Why is central neck dissection problematic?from entokey.com
The surgical literature on central neck dissection is problematic because of a lack of standardization in data reporting and anatomic definitions. The ATA consensus manuscript indicates that at a minimum, to qualify as central neck dissection the dissection must include prelaryngeal, pretracheal, and at least one paratracheal nodal basin.
What is the pretracheal dissection?from entokey.com
The pretracheal dissection is analogous to a prelaryngeal dissection but starts at the lower margin of the isthmus and strips the fibrofatty soft tissue and nodes from the front face of the trachea down to the level of the innominate crossing of the trachea. Careful palpation prior to the inferior-most aspect of the dissection is necessary to digitally identify the innominate artery. Care is taken also to not injure the more ventrally placed brachiocephalic vein. An alternative to this approach would be to reserve the inferior border of the pretracheal dissection until the right paratracheal node dissection is complete and the innominate artery would have already been elucidated. Because of the size of these potential feeding vessels, small branches to and from the pretracheal region lymph nodes should be securely controlled. It is important when performing a pretracheal dissection to not extend the trachea dissection off the front face of the trachea and down into the paratracheal region. This can jeopardize the recurrent laryngeal nerve especially on the left side given the left RLN’s more typical medial tracheoesophageal groove position as compared to the right. It is tempting during pretracheal dissection when encountering a lateral node to try and deliver it up onto the trachea, but such a maneuver we feel does engender risk to the recurrent laryngeal nerve as noted earlier, especially on the left side. Any clear-cut paratracheal nodes are identified and then dealt with during the paratracheal dissection portion of the case when the recurrent laryngeal nerve is fully identified and dissected.
What are the levels of lymph nodes in the neck?from entokey.com
The central neck includes lymph node levels VI and VII. Level VI lymph nodes fall within the following boundaries: superior (the hyoid bone), inferior (the sternal notch), lateral (the carotid artery), posterior (the prevertebral fascia), and anterior (the undersurface of the sternothyroid muscles). Level VII lymph nodes are those associated great vessels superior mediastinal including the brachiocephalic vein and innominate artery and are included as the lowest portions of the ATA-defined central neck dissection. The approximate level of the innominate crossing of the trachea essentially defines the inferior border, on the cranial caudal axis, of central neck dissection. It should be acknowledged that this is an arbitrary inferior border designation when it comes to the left paratracheal region because the innominate artery does not extend to the left paratracheal region. Also the sternal notch and the innominate artery have a variable relationship with the artery rising above the notch in 25% of cadaveric dissections. 29 Mediastinal lymphadenopathy located caudal to the brachiocephalic vein adjacent to the tracheal bifurcation is rare in patients with existing central neck metastases and is significantly related to poor tumor differentiation, and the presence of distant metastases and can be identified by preoperative CT scanning. 30 Blood supply of lower paratracheal and pretracheal nodes may originate from the aortic arch and drain to subclavian or brachiocephalic veins. Adequately securing these often small diameter vessels is important during central neck dissection.
How many paratracheal nodes are there?from entokey.com
The number of nodes in the paratracheal regions range from 3 to 30 in number. 31 Harrison in cadaveric and clinical dissections found 2 to 10 paratracheal nodes per side. 32 Pereira has shown CND is typically associated with an average of 8 nodes on pathologic examination. 33
What is vertical incision?from entokey.com
A vertical incision opens the midline between the strap muscles, from the thyroid notch to the sternal notch. Loupe magnification can be helpful in parathyroid and nerve identification during thyroidectomy and has great utility as well in central neck dissection.
Which regions of the neck are nodal bearing?from entokey.com
Figure 38-1 The four major regions that constitute most important nodal-bearing regions within the central neck include prelaryngeal (Delphian) (A), pretracheal (C), and bilateral paratracheal (B and D).
Where are the prelaryngeal nodes?from entokey.com
The prelaryngeal nodes are easily visualized during the resection of the pyramidal lobe. They can be dissected at this time or after thyroidectomy. The prelaryngeal dissection starts inferiorly at the upper margin of the thyroid isthmus and extends superiorly to the anterior arch of the cricoid cartilage. The dissection extends superiorly into the tissue over the cricothyroid membrane and then over the anterior surface of the thyroid cartilage up to the thyroid notch. Nodal tissue may be residing in the indented cricothyroid membrane, so dissection in the area of the cricothyroid membrane must extend deeply enough to recognize and excise such Delphian nodes. The fascia over the cricothyroid muscle should be preserved, and all soft tissue should be dissected off this area preserving the perichondrium of the respective cartilages. Special care is taken to avoid injury to the cricothyroid muscles. There is often a small bleeder on the surface of the cricothyroid muscle, but cautery on the surface of the muscles is ill advised. Given the muscle’s thinness, such cautery injury would significantly disrupt muscular function with a possible postoperative pattern of dysfunction similar to superior laryngeal nerve paralysis. A pyramidal lobe, if present, is dissected as part of this initial prelaryngeal dissection and is reflected downward on to the thyroid. The orientation that is provided to the surgeon by this initial brief prelaryngeal dissection is helpful in that the exact midline, the anterior arch of the cricoid, and the cricothyroid muscles are all clearly identified, providing helpful anatomic information for later portions of the case (see Chapter 30, Principles in Thyroid Surgery).
What is central neck dissection?
Level VI neck dissection and central neck dissection are terms often used interchangeably to describe surgical excision of all lymph nodes from the hyoid bone to the sternal notch between the carotid arteries, but the addition of the superior mediastinal lymph nodes in compartment VII should be included in the central …
What is the CPT code for central neck dissection?
CPT code 60252 is reported when a limited neck dissection is done, while CPT code 60254 is reported if a radical neck dissection is included in the procedure.
What is the CPT code 60240?
The Current Procedural Terminology (CPT ®) code 60240 as maintained by American Medical Association, is a medical procedural code under the range – Excision Procedures on the Thyroid Gland.
What is procedure code 19303?
The correct code to report skin-sparing mastectomy is 19303, Mastectomy, simple, complete (total mastectomy).
Why do a neck dissection?
Neck dissection is usually performed to remove cancer that has spread to lymph nodes in the neck. Lymph nodes are small bean shaped glands scattered throughout the body that filter and process lymph fluid from other organs. The immune cells in the lymph nodes help the body fight infection.
What does CPT code 38792 mean?
Clarify the note: CPT’s note with 38792 does state, “For nuclear medicine lymphatics and lymph gland imaging, use 78195.” You may want to add your own reminder that the instruction means to use 78195 to report both injection and imaging.
How long does a neck dissection surgery take?
The area for surgery is often marked to make sure there are no errors. You will be kept comfortable and safe by your anesthesia provider. You will be asleep during the surgery. The surgery will take about 2 to 4 hours.
