Summary & Overview
CPT 38300: Incision and Drainage of Enlarged or Infected Lymph Node
CPT code 38300 represents a focused surgical procedure: incision and drainage of an enlarged or inflamed lymph node to evacuate an abscess or infected material. This procedure is commonly performed when conservative measures fail or when an abscess poses a risk of spread; it is relevant across inpatient and outpatient surgical settings and in emergency care. Nationally, accurate coding of 38300 matters for clinical documentation, appropriate service setting designation, and payer adjudication.
Key payers in coverage discussions include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise overview of clinical context for the procedure, common settings where the service is furnished, and the payer landscape covered in the publication. The analysis includes benchmark considerations for billing and reimbursement patterns, typical documentation elements that support medical necessity, and any notable policy updates affecting coverage and payment where available.
This resource is intended to help billing professionals, clinical coders, and policy analysts understand how CPT code 38300 is used, what supporting clinical details are important, and which payers commonly appear in coverage policies and claims adjudication nationally.
Billing Code Overview
CPT code 38300 describes an incision and drainage procedure of an enlarged or inflamed lymph node to evacuate an abscess or infectious material. This is a surgical service that involves making an incision directly over the affected lymph node to drain pus and control local infection.
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Service type: Surgical incision and drainage of lymph node
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Typical site of service: Ambulatory surgical center, hospital outpatient department, or emergency department, depending on clinical urgency and patient condition
Clinical & Coding Specifications
Clinical Context
A typical patient is an adult presenting to the emergency department or outpatient surgical clinic with a painful, erythematous, fluctuant, and enlarged lymph node consistent with an infected or suppurative lymphadenitis. The patient often reports progressive localized swelling, tenderness, fever, and sometimes purulent drainage or overlying cellulitis. Physical exam reveals a discrete, fluctuant mass amenable to incision and drainage.
Evaluation typically includes history, focused physical examination, and, when indicated, bedside ultrasound to confirm fluid collection and guide incision location. Laboratory testing may include a complete blood count and inflammatory markers; wound culture may be obtained at the time of incision. The procedure occurs under local anesthesia in an outpatient procedure room, emergency department, or minor operating suite. The provider makes an incision over the node, expresses purulent material, irrigates the cavity, may place a small drain or packing if needed, and instructs the patient on wound care and antibiotics. Follow-up is arranged within 48–72 hours for reassessment and potential packing removal, culture result review, and escalation of care if deep infection or systemic signs persist.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
25 | Significant, separately identifiable evaluation and management service by the same physician on the same day of the procedure | Use when a distinct E/M is documented in addition to the incision and drainage at the same encounter. |