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2025 CPT code 38520

Biopsy or excision of deep cervical lymph node(s) with excision of the scalene fat pad.

Code 38520 is reported only once per operative session, regardless of the number of deep cervical lymph nodes biopsied or excised. For bilateral procedures, modifier 50 can be appended.If a sentinel lymph node biopsy procedure (38792) is performed, do not report 38520.

Modifiers may be applicable to this code.Modifier 50 is used for bilateral procedures. Other modifiers, such as 22 (increased procedural services), may be appropriate depending on the complexity of the case.

Medical necessity is established by the presence of signs, symptoms, or diagnostic findings (imaging studies, other biopsies) suggestive of a condition that requires pathological evaluation or surgical treatment of the deep cervical lymph nodes.

The surgeon is responsible for the entire surgical procedure, from positioning and prepping the patient to making the incision, carefully dissecting and preserving vital structures (like nerves and ducts), excising the nodes and fat pad, controlling bleeding, placing a drain if needed, and closing the incision.

In simple words: This procedure involves removing lymph nodes located deep in the neck, along with a nearby fatty tissue called the scalene fat pad.The surgeon makes an incision to access these tissues, removes them, and then sends them to a lab for examination. This helps determine if there is any disease present and guides further treatment.

Open biopsy or excision of one or more deep cervical lymph nodes is performed along with the excision of the scalene fat pad.The procedure may be done for diagnostic or therapeutic purposes. The excised tissues are usually sent for pathological analysis.

Example 1: A patient presents with a suspicious mass in the neck.A fine-needle aspiration biopsy is inconclusive. An open biopsy of the deep cervical lymph nodes and scalene fat pad is performed to obtain a definitive diagnosis., A patient with a known malignancy in the head and neck region undergoes a planned neck dissection to assess for lymph node involvement. During the procedure, deep cervical nodes and the scalene fat pad are excised for pathological staging., A patient has enlarged deep cervical lymph nodes that are concerning for lymphoma.The nodes and scalene fat pad are excised for diagnostic evaluation.

Documentation should include details about the location and size of the biopsied or excised lymph node(s), the size of the incision, the operative technique, the presence of any complications, and the findings of the pathological examination.Medical necessity should be clearly documented based on the clinical presentation, diagnostic results, or treatment plan.

** This procedure addresses deep cervical nodes, not superficial ones. The distinction is important for accurate coding.

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