Crystal's MCW Coder Hub🧬 CPT 38720 — Cervical Lymphadenectomy, Radical (Radical Neck Dissection)
Code Description
CPT 38720 describes a radical cervical lymphadenectomy, also known as a classic radical neck dissection (RND). This procedure involves the comprehensive, en-bloc removal of all five cervical lymph node levels (Levels I-V) on the ipsilateral side of the neck, along with three non-lymphatic structures that define it as “radical”:
- The internal jugular vein (IJV)
- The sternocleidomastoid muscle (SCM)
- The submandibular gland (SMG)
This is the most extensive form of neck dissection, originally described by George Crile in 1906, and represents the oncologic gold standard for cervically metastatic head and neck carcinoma when there is tumor involvement of or adherence to the above non-lymphatic structures. The procedure is performed through an open cervical approach, typically under general anesthesia.
Sacrifice of the internal jugular vein can result in elevated intracranial pressure, particularly if bilateral dissections are performed simultaneously. Sacrifice of the sternocleidomastoid muscle results in significant cosmetic deformity and reduced neck contour. Sacrifice of the submandibular gland is required due to its proximity to Level I nodal tissue and the risk of direct invasion or satellite metastasis.
Operative Overview
The surgeon makes an incision (typically a MacFee, apron, or modified Schobinger incision) to expose the neck from the mandible to the clavicle. The dissection proceeds in a systematic fashion removing the lymph node-bearing fibrofatty tissue within the following cervical levels:
- Level I — Submental and submandibular triangles (includes submandibular gland)
- Level II — Upper jugular nodes (jugulodigastric, upper internal jugular chain), from skull base to hyoid
- Level III — Middle jugular nodes, hyoid to cricothyroid membrane
- Level IV — Lower jugular nodes, cricothyroid membrane to clavicle
- Level V — Posterior triangle nodes (spinal accessory chain and transverse cervical chain)
The internal jugular vein is ligated superiorly near the jugular foramen and inferiorly at the subclavian confluence. The sternocleidomastoid muscle is transected at its mastoid and sternal/clavicular origins. The spinal accessory nerve (CN XI) is typically sacrificed in a true radical dissection, resulting in significant shoulder dysfunction and trapezius denervation — this distinguishes it from the modified radical neck dissection (CPT 38724).
Includes
- En-bloc removal of ipsilateral cervical lymph nodes, Levels I-V
- Resection of the internal jugular vein
- Resection of the sternocleidomastoid muscle
- Resection of the submandibular gland
- Ligation of the internal jugular vein (superior and inferior)
- Dissection and identification of the carotid artery and vagus nerve (preserved)
- Surgical wound closure
Excludes / Not Included — Code Separately
- Contralateral neck dissection — a separate neck dissection on the opposite side is reported separately (e.g., bilateral radical neck dissection requires two separate CPT codes with modifier -50 or two line items)
- Thyroidectomy — if performed at the same session, report separately (CPT 60240, 60252, 60254)
- Parotidectomy — report separately (CPT 42410-42426)
- Primary tumor resection — laryngectomy (CPT 31360-31395), glossectomy (CPT 41140-41155), mandibulectomy (CPT 21040-21049), etc. are all reported separately
- Reconstructive procedures — regional or free flap reconstruction (CPT 15756, 15757, 15758) reported separately
- Tracheostomy — if performed at same operative session, code separately (CPT 31600, 31601, 31603)
- Frozen section pathology — reported by pathology, not by surgeon
Related CPT Codes — Neck Dissection Code Tree
| CPT Code | Description |
|---|---|
| 38700 | Suprahyoid lymphadenectomy (Level I only) |
| 38720 | Cervical lymphadenectomy, radical (Levels I-V + IJV + SCM + SMG) — this code |
| 38724 | Cervical lymphadenectomy, modified radical (Levels I-V, preserving SCM, IJV, or CN XI) |
| 38542 | Dissection, deep jugular node(s) |
| 38500 | Biopsy or excision of lymph node(s), open, superficial |
| 38510 | Biopsy or excision of lymph node(s), open, deep cervical node(s) |
| 38530 | Biopsy or excision of lymph node(s), open, internal mammary |
| 38900 | Intraoperative identification (sentinel node) with injection of radiopharmaceutical |
Key Distinction — 38720 vs. 38724: CPT 38720 (radical) requires removal of ALL THREE non-lymphatic structures: IJV + SCM + SMG. CPT 38724 (modified radical) preserves one or more of the following: the spinal accessory nerve (CN XI), the internal jugular vein, or the sternocleidomastoid muscle. If even one of these structures is preserved, the procedure qualifies as a modified radical neck dissection (38724), not a radical neck dissection (38720). Always review the operative report for explicit documentation of which structures were sacrificed vs. preserved.
ICD-10-PCS Equivalents (Inpatient)
For inpatient facility coding, CPT 38720 maps to ICD-10-PCS resection codes of the cervical lymphatics. Additional codes are required to capture resection of the IJV, SCM, and submandibular gland.
| ICD-10-PCS Code | Description |
|---|---|
| 07T10ZZ | Resection of Right Neck Lymphatic, Open Approach |
| 07T20ZZ | Resection of Left Neck Lymphatic, Open Approach |
| 07T30ZZ | Resection of Right Upper Extremity Lymphatic, Open Approach (not applicable) |
| 06T10ZZ | Resection of Right Internal Jugular Vein, Open Approach (IJV sacrifice, right) |
| 06T20ZZ | Resection of Left Internal Jugular Vein, Open Approach (IJV sacrifice, left) |
| 0KT20ZZ | Resection of Right Neck Muscle, Open Approach (SCM resection, right) |
| 0KT30ZZ | Resection of Left Neck Muscle, Open Approach (SCM resection, left) |
| 0CT00ZZ | Resection of Right Submandibular Gland, Open Approach |
| 0CT10ZZ | Resection of Left Submandibular Gland, Open Approach |
Inpatient Coding Note:
ICD-10-PCS requires coding each distinct root operation on each distinct body part separately. A full right radical neck dissection could require four or more ICD-10-PCS codes to fully capture the procedure. The principal procedure code should reflect the most definitive/resource-intensive component — typically the lymph node resection (07T10ZZ or 07T20ZZ).
Common ICD-10-CM Diagnosis Codes
The following diagnoses are the most common indications for CPT 38720 / radical neck dissection:
| ICD-10-CM | Description | HCC |
|---|---|---|
| C10.9 | Malignant neoplasm of oropharynx, unspecified | HCC 11 |
| C10.0 | Malignant neoplasm of vallecula | HCC 11 |
| C10.1 | Malignant neoplasm of anterior epiglottis | HCC 11 |
| C10.2 | Malignant neoplasm of lateral wall of oropharynx | HCC 11 |
| C10.3 | Malignant neoplasm of posterior wall of oropharynx | HCC 11 |
| C11.9 | Malignant neoplasm of nasopharynx, unspecified | HCC 11 |
| C12 | Malignant neoplasm of pyriform sinus | HCC 11 |
| C13.9 | Malignant neoplasm of hypopharynx, unspecified | HCC 11 |
| C14.0 | Malignant neoplasm of pharynx, unspecified | HCC 11 |
| C30.0 | Malignant neoplasm of nasal cavity | HCC 11 |
| C31.9 | Malignant neoplasm of accessory sinus, unspecified | HCC 11 |
| C32.0 | Malignant neoplasm of glottis | HCC 11 |
| C32.1 | Malignant neoplasm of supraglottis | HCC 11 |
| C32.9 | Malignant neoplasm of larynx, unspecified | HCC 11 |
| C41.0 | Malignant neoplasm of bones of skull and face | HCC 11 |
| C44.301 | Unspecified malignant neoplasm of skin of nose | HCC 12 |
| C73 | Malignant neoplasm of thyroid gland | HCC 11 |
| C77.0 | Secondary and unspecified malignant neoplasm of lymph nodes of head, face and neck | HCC 12 |
| C76.0 | Malignant neoplasm of head, face and neck | HCC 11 |
| C80.1 | Malignant (primary) neoplasm, unspecified | HCC 12 |
HCC Note:
Most head and neck primary malignancies and secondary lymph node metastases map to HCC 11 (Colorectal, Bladder, and Other Cancers) or HCC 12 (Breast, Prostate, and Other Cancers and Tumors) under CMS-HCC v24/v28. These HCCs carry significant RAF weight and should always be captured with full specificity when documented by the treating physician. Cervical lymph node metastasis (C77.0) should be coded when metastatic disease is present and should be coded in addition to the primary site malignancy.
wRVU and Reimbursement
| Metric | Value |
|---|---|
| Work RVU (wRVU) | 22.45 |
| Total RVU (national average) | ~36.00 (facility) |
| Global Period | 90 days |
| Assistant Surgeon Payable | Yes — assistant surgeon is payable; supports modifier -80, -82, or -AS |
| Co-Surgeon | May be applicable; modifier -62 with documentation of distinct surgical skills |
| Teaching Physician | Modifier -GC applicable in academic settings |
| Bilateral | Not applicable as a single code; report second side separately |
| Professional / Technical Split | Professional component only; no TC/26 modifiers apply |
Assistant Payable Detail:
CPT 38720 is a high-complexity open neck dissection requiring significant operative exposure, hemostasis of major vascular structures, and simultaneous management of cranial nerves. An assistant surgeon is medically necessary and is payable by Medicare and most commercial payers. Documentation should reflect that the complexity of the case required a second surgeon (or first assistant). APPs functioning as first assistants should bill modifier -AS under their own NPI when applicable.
MS-DRG Assignment
Radical neck dissection is frequently performed in the inpatient setting, particularly when combined with primary tumor resection of the larynx, pharynx, or oral cavity. The MS-DRG assigned depends heavily on the principal diagnosis and whether the procedure is performed alone or in conjunction with other major head and neck procedures.
| MS-DRG | Description | Type |
|---|---|---|
| 166 | Other Ear, Nose, Mouth & Throat O.R. Procedures with MCC | Surgical |
| 167 | Other Ear, Nose, Mouth & Throat O.R. Procedures with CC | Surgical |
| 168 | Other Ear, Nose, Mouth & Throat O.R. Procedures without CC/MCC | Surgical |
| 146 | Ear, Nose, Mouth & Throat Malignancy with MCC | Medical (if no qualifying OR procedure is principal) |
| 147 | Ear, Nose, Mouth & Throat Malignancy with CC | Medical |
| 148 | Ear, Nose, Mouth & Throat Malignancy without CC/MCC | Medical |
MS-DRG Coding Note:
When radical neck dissection is performed with a laryngectomy or major resection, the more resource-intensive procedure typically drives the MS-DRG. For example, a total laryngectomy with bilateral radical neck dissection will likely group to MS-DRG 166/167/168 or potentially a higher-weighted DRG depending on CC/MCC status. Always ensure the principal procedure is designated accurately on the UB-04 claim to optimize appropriate MS-DRG assignment. MCC conditions such as sepsis, respiratory failure, or malnutrition (E40-E46) will significantly impact DRG weight and reimbursement.
Coding Examples
Example 1 — Radical Neck Dissection with Total Laryngectomy for Laryngeal Carcinoma
A 62-year-old male with T3N1M0 squamous cell carcinoma of the supraglottis undergoes a total laryngectomy with right radical neck dissection. The operative report documents removal of lymph node Levels I-V, sacrifice of the right internal jugular vein and right sternocleidomastoid muscle, and excision of the right submandibular gland.
CPT Codes:
- 31360 — Total laryngectomy, without radical neck dissection
- 38720 — Cervical lymphadenectomy, radical (right)
ICD-10-CM:
- C32.1 — Malignant neoplasm of supraglottis (principal diagnosis)
- C77.0 — Secondary malignant neoplasm of lymph nodes of head, face and neck
ICD-10-PCS (Inpatient):
- 0CTR0ZZ — Resection of larynx, open
- 07T10ZZ — Resection of right neck lymphatic, open approach
- 06T10ZZ — Resection of right internal jugular vein, open approach
- 0KT20ZZ — Resection of right neck muscle (SCM), open approach
- 0CT00ZZ — Resection of right submandibular gland, open approach
Example 2 — Radical Neck Dissection for Thyroid Carcinoma with Lymph Node Metastasis
A 48-year-old female with papillary thyroid carcinoma and ipsilateral cervical lymph node metastasis undergoes a total thyroidectomy with left radical neck dissection. The IJV, SCM, and submandibular gland on the left are all resected en-bloc. The spinal accessory nerve is sacrificed.
CPT Codes:
- 60240 — Total thyroidectomy
- 38720-LT — Cervical lymphadenectomy, radical (left side; use -LT modifier for laterality)
ICD-10-CM:
- C73 — Malignant neoplasm of thyroid gland
- C77.0 — Secondary malignant neoplasm of lymph nodes of head, face and neck
Example 3 — Bilateral Neck Dissection (Radical Right, Modified Radical Left)
A 57-year-old male with oropharyngeal SCC undergoes resection of the primary oropharyngeal tumor, right radical neck dissection (all 3 non-lymphatic structures removed), and left modified radical neck dissection (SCM preserved, CN XI preserved, IJV removed). This combination is coded as two separate neck dissection codes.
CPT Codes:
- 42890 or appropriate oropharyngeal resection code
- 38720 — Radical neck dissection, right
- 38724 — Modified radical neck dissection, left
Do NOT use modifier -50 here because the right and left sides involve different types of neck dissection. Each is coded individually with laterality documented in the operative report.
Example 4 — Incorrect Coding Scenario (Audit Red Flag)
A surgeon documents “radical neck dissection” in the operative report title but the body of the report states that the spinal accessory nerve and sternocleidomastoid muscle were preserved; only the internal jugular vein was sacrificed. This procedure does NOT meet the definition of CPT 38720.
- Incorrect: 38720 (radical neck dissection)
- Correct: 38724 (modified radical neck dissection — one non-lymphatic structure sacrificed)
Documentation Tip: The title of the procedure alone is not sufficient to support CPT code selection. The body of the operative report must explicitly document removal of the IJV, SCM, and SMG to support 38720. When in doubt, query the surgeon for clarification before code assignment.
Documentation Requirements
To support CPT 38720, the operative report must include:
- Indication — documented malignancy or suspected metastatic disease requiring oncologic neck dissection
- Laterality — right vs. left (or bilateral)
- Lymph node levels dissected — explicit mention of which levels were cleared (I-V for radical)
- Non-lymphatic structures sacrificed — must document all three: internal jugular vein, sternocleidomastoid muscle, and submandibular gland
- Vascular ligation — documentation of IJV ligation, superior and inferior
- Nerve identification and management — documentation of cranial nerve identification (vagus, hypoglossal, spinal accessory)
- Specimen submission — pathology report confirming lymph node tissue, glandular tissue, and/or vascular/muscular structures
Clinical Notes for Coders
- Spinal accessory nerve (CN XI) sacrifice is implied in a true radical neck dissection but is not part of the CPT code definition. Its sacrifice/preservation helps distinguish radical from modified radical but is not a discrete CPT code driver.
- Neck dissection classification has evolved significantly. The terms “radical,” “modified radical,” “selective,” and “extended” have specific CPT correlates. Coders should always refer to the operative body, not just the header, for structure-specific documentation.
- Chyle leak / thoracic duct injury — if the thoracic duct is inadvertently injured and repaired, this is generally not separately reportable unless a distinct repair procedure is performed.
- Drain placement — closed suction drain placement is included in the global package and is not separately reportable.
- Frozen section — intraoperative pathology consultation (CPT 88331) is billed by the pathologist and is not separately reportable by the surgeon.
- When neck dissection is performed for thyroid carcinoma, ensure the primary thyroid malignancy code (C73) is listed along with any lymph node metastasis (C77.0). Papillary thyroid carcinoma has a strong predilection for cervical lymph node involvement and the presence of C77.0 is clinically and financially significant for HCC and DRG weight.