Summary & Overview
CPT 38500: Open Excision or Biopsy of Superficial Lymph Node(s)
CPT code 38500 represents an open excision or biopsy of superficial lymph nodes performed with a scalpel to obtain tissue for diagnostic evaluation. This surgical procedure is commonly used to diagnose infections, malignancies, or inflammatory conditions affecting lymph nodes near the surface of the body. Nationally, correct coding and clinical documentation for this procedure affect claims adjudication, surgical quality reporting, and pathology processing.
Key payers covered in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find an overview of clinical context for using CPT code 38500, typical sites of service, and commonly associated billing modifiers. The publication summarizes benchmarks for utilization and reimbursement patterns where available, outlines common coding pitfalls, and highlights policy or coverage considerations relevant to payers and providers. The material is intended for coding professionals, surgical clinicians, billing teams, and policy analysts seeking a concise, national-level reference on coding and clinical scope for superficial lymph node excision/biopsy.
Billing Code Overview
CPT code 38500 describes an open excision or biopsy of superficial lymph nodes using a scalpel. The procedure involves the surgical removal of one or more lymph nodes that lie near the surface of the body for diagnostic evaluation or to identify the cause of disease in the lymph nodes or surrounding tissues.
Service Type: Surgical biopsy / excision of superficial lymph node(s)
Typical Site of Service: Outpatient surgical suite, hospital operating room, or ambulatory surgical center
Clinical & Coding Specifications
Clinical Context
A 54-year-old female presents to the outpatient surgical clinic with a persistent, non-tender, palpable lymph node in the left cervical region that has enlarged over six weeks despite conservative management. Physical exam localizes a single superficial mobile node just under the skin. Ultrasound shows a solid lymph node without obvious abscess. The provider schedules an open excisional lymph node biopsy to obtain tissue for histopathology and immunohistochemistry to evaluate for malignancy, lymphoma, or chronic infection. The patient arrives on the day of service, consents for the procedure, and undergoes local or monitored anesthesia care in an ambulatory surgery center or hospital outpatient department. The provider uses sterile technique, makes a skin incision over the superficial node, dissects to the capsule, excises the entire node with minimal surrounding tissue, achieves hemostasis, and closes the wound. Specimen is sent to pathology with appropriate labeling and requisition. Postoperative instructions and wound care are provided and the patient is discharged the same day with follow-up arranged for results and potential further staging or therapy planning based on pathology.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
25 | Significant, separately identifiable evaluation and management service on the same day as a procedure | Use when a distinct E/M service was performed and documented on the same day as the excisional biopsy. |
| | Professional component | Use if reporting only the physician’s professional component of a service when a technical component is billed separately (rare for excision but applicable if pathology technical services billed separately).