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38500

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🧬CPT 38500: Biopsy or Excision of Lymph Node(s); Open, Superficial

1. CPT Code Description

Official Descriptor

Biopsy or excision of lymph node(s); open, superficial (eg, cervical, inguinal, axillary)

Detailed Explanation

CPT code 38500 describes a surgical procedure where one or more superficial lymph nodes are removed for examination. This is an open procedure, meaning the physician makes an incision in the skin to directly visualize and remove the node(s), as opposed to a needle biopsy.

The primary purpose is diagnostic—to determine the cause of lymphadenopathy (enlarged lymph nodes), which could be due to infection, inflammation, or malignancy (like lymphoma or metastasis).

The key term is “superficial.” This refers to lymph nodes located in the subcutaneous tissue, just beneath the skin, and not deep within the body cavity or beneath the deep fascia. These nodes are typically easily palpable. Common sites include the neck (cervical), groin (inguinal), and armpit (axillary), but can be anywhere on the body where superficial nodes are present.

2. Code Details & Reimbursement

  • Work RVU (wRVU): 3.86 (Note: RVUs are subject to change annually by CMS)
  • Global Period: 10 days. This means all typical pre-operative and post-operative care related to the procedure within 10 days of the surgery is included in the payment for 38500.
  • Assistant at Surgery Payable: No. The Medicare Physician Fee Schedule (MPFS) indicator is “2,” which means an assistant surgeon’s services are not eligible for reimbursement for this procedure.
  • MS-DRG: This CPT code is for the professional fee. The facility fee for an inpatient stay would be assigned an MS-DRG based on the principal diagnosis. Common MS-DRGs where this procedure might be performed include:
    • MS-DRG 823-825: Malignant Lymphoma & Leukemia with/without Major Complication/Comorbidity (MCC/CC)
    • MS-DRG 602-603: Cellulitis with/without MCC/CC
    • MS-DRG 846-848: Other Hemic & Lymphatic System O.R. Procedures with/without MCC/CC

3. CPT Code Tree (Hierarchy)

  • Surgery
    • Hemic and Lymphatic Systems (38100-38999)
      • Lymph Nodes and Lymphatic Channels (38500-38794)
        • Excision
          • 38500 - Biopsy or excision of lymph node(s); open, superficial…
          • 38505 - Biopsy or excision of lymph node(s); by needle, superficial… (Note: This is a needle biopsy, not open)
          • 38510 - Biopsy or excision of lymph node(s); open, deep cervical node(s)
          • 38520 - Biopsy or excision of lymph node(s); open, deep cervical node(s) with special dissection
          • 38525 - Biopsy or excision of lymph node(s); open, deep axillary node(s)

4. Coding Guidelines & Nuances

Includes

The reimbursement for 38500 is considered to cover the following components of the service:

  • Local or regional anesthesia administered by the operating surgeon.
  • Making the skin incision over the target lymph node.
  • Dissection through the subcutaneous tissue to expose the node(s).
  • The complete excision (removal) or incisional biopsy of one or more lymph nodes through the same incision.
  • Obtaining hemostasis (controlling bleeding).
  • Simple (non-layered) or intermediate (layered) wound closure.

Excludes

Do not use 38500 for the following procedures. They should be coded separately:

  • Deep Lymph Node Biopsy: If the lymph node is located beneath the deep fascia (e.g., deep in the neck near major vessels, deep in the axilla, or in the retroperitoneum), use codes like 38510, 38520, 38525, or 38530. The distinction between superficial and deep is critical and must be clearly documented.
  • Sentinel Lymph Node Biopsy: This specialized procedure to identify the first draining lymph node from a tumor site is coded with 38531.
  • Fine Needle Aspiration (FNA): If a needle is used to aspirate cells rather than an open excision, use codes from the 10004-10021 series.
  • Radical Lymphadenectomy: More extensive removal of a chain of lymph nodes is coded with other specific codes (e.g., 38720 for a cervical lymphadenectomy).
  • Pathology Services: The pathologist’s examination of the removed tissue is billed separately with codes like 88305.
  • Imaging Guidance: If ultrasound or other imaging is used to guide the procedure, it may be separately reportable (e.g., 76942 for ultrasonic guidance for needle placement).

Modifier Usage

  • Modifier -50 (Bilateral Procedure): Use if superficial nodes are excised from symmetrical sites (e.g., both left and right inguinal areas) during the same operative session.
  • Modifier -59 (Distinct Procedural Service): Use if 38500 is performed at a different anatomical site (e.g., left neck and left axilla) through a separate incision during the same session. Anatomic modifiers (-LT, -RT) and X-modifiers (-XS, -XP, etc.) should also be used to specify the sites.
  • Modifier -51 (Multiple Procedures): If 38500 is performed along with another unrelated procedure, Modifier 51 may be appended to the lesser-valued procedure.

5. Coding Examples

Example 1: Single Site Inguinal Lymph Node Biopsy

  • Clinical Scenario: A 45-year-old male presents with a persistently swollen and firm, non-tender 2 cm lymph node in his right groin that has been present for 3 months. The physician performs an open excisional biopsy of the superficial inguinal node under local anesthesia. The wound is closed in layers. The specimen is sent to pathology.
  • CPT Code: 38500-RT
  • ICD-10-CM Codes:
    • R59.0 - Localized enlarged lymph nodes (Initial diagnosis)
    • After pathology returns as lymphoma: C85.93 - Non-Hodgkin lymphoma, unspecified, inguinal region and lower limb
      • HCC: Yes, HCC Category 8 for Malignant Neoplasms.

Example 2: Multiple Superficial Sites

  • Clinical Scenario: A 62-year-old female with a history of melanoma is found to have two new palpable lymph nodes: one in the left supraclavicular region and one in the left axilla. The surgeon decides to excise both for staging. Two separate incisions are made, one over the clavicle and one in the axilla, and a superficial node is removed from each location.
  • CPT Codes:
    • 38500-LT (for the first site, e.g., supraclavicular)
    • 38500-59-LT (for the second, distinct site, e.g., axillary)
    • Note: Payer policies may vary; some may prefer 38500 on one line with 2 units and a modifier.
  • ICD-10-CM Codes:
    • C43.9 - Malignant melanoma of skin, unspecified
    • C77.0 - Secondary and unspecified malignant neoplasm of lymph nodes of head, face and neck (for the supraclavicular node)
      • HCC: Yes, HCC Category 10 for Lung, and Other Severe Cancers.
    • C77.3 - Secondary and unspecified malignant neoplasm of axilla and upper limb lymph nodes
      • HCC: Yes, HCC Category 10.

Example 3: Incorrect Use Case (Deep Node)

  • Clinical Scenario: A patient has a deeply embedded, non-palpable lymph node in the neck, adjacent to the carotid artery, identified on a CT scan. The surgeon must dissect through the platysma muscle and retract major vessels to access and excise the node.
  • This is NOT coded with 38500.
  • Correct CPT Code: This would be coded as 38510 (Biopsy or excision of lymph node(s); open, deep cervical node(s)) or potentially 38520 if it required extensive dissection. The key is the documented location deep to the fascia and the complexity of the approach.

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