Summary & Overview
CPT 38720: Complete Cervical Lymph Node Excision
CPT code 38720 denotes a complete cervical lymphadenectomy — the surgical removal of lymph nodes and potentially adjacent tissues from the neck, commonly performed for metastatic cancer or other regional disease. This code captures a definitive surgical management step in oncologic and infectious indications where comprehensive nodal clearance is clinically indicated. Nationally, procedures coded with 38720 are relevant for surgical outcomes, perioperative resource use, and post-surgical surveillance patterns.
Key payers discussed include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Coverage and payment policies for cervical lymphadenectomy vary by payer and plan type, affecting settings of care (inpatient versus outpatient), prior authorization practices, and coding documentation requirements.
Readers will find practical context on the clinical intent of 38720, typical sites of service, and the kinds of benchmarks and policy issues that influence utilization and reimbursement. The publication outlines expected data elements and metrics that organizations monitor for this surgery, highlights common billing complexities, and summarizes the policy landscape that payers and providers navigate for head and neck lymph node excision procedures. Data not available in the input will be identified as such in detailed sections.
Billing Code Overview
CPT code 38720 describes a complete excision of lymph nodes from the cervical (neck) region. The procedure involves removing lymphatic tissue and, when necessary for disease control such as metastatic cancer, adjacent tissues in the cervical area.
Service Type: Surgical — Cervical (neck) lymphadenectomy
Typical Site of Service: Hospital operating room or ambulatory surgical center, performed by surgical specialists (for example, otolaryngology/head and neck surgery or surgical oncology) under general anesthesia.
Clinical & Coding Specifications
Clinical Context
A typical patient is a 62-year-old individual with a history of head and neck squamous cell carcinoma who presents with a palpable, enlarging cervical lymph node and imaging evidence of nodal metastasis. The multidisciplinary team (otolaryngology-head and neck surgery, medical oncology, radiation oncology) discusses neck management and elects a therapeutic complete neck dissection due to documented metastatic disease. The patient undergoes preoperative evaluation including history/physical, cross-sectional imaging (CT or MRI of the neck), and appropriate labs. In the operating room under general anesthesia the surgeon performs a comprehensive cervical lymphadenectomy, removing lymph node levels I–V and associated non-lymphatic tissues as indicated by tumor extent. Specimens are labeled by level and submitted to pathology for histologic staging and margins. Postoperative care includes inpatient monitoring for airway, bleeding, pain control, and evaluation for cranial nerve deficits; adjuvant therapy decisions are based on final pathology. Billing is submitted for the complete neck dissection using 38720 with applicable modifiers to reflect the professional, technical, laterality, and circumstance-specific adjustments.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
51 | Multiple procedures | When other distinct surgical procedures are performed at the same operative session in addition to the neck dissection |
52 | Reduced services | When the procedure is partially reduced or not completed as originally planned |
53 | Discontinued procedure | When the procedure is stopped due to extenuating circumstances after anesthesia is administered |
59 | Distinct procedural service | When a separate, distinct procedure unrelated to the neck dissection is performed at the same session |
62 | Two surgeons | When two surgeons work together as primary surgeons performing distinct parts of the procedure |
66 | Surgical team | When a surgical team, rather than a single surgeon, performs the operation |
78 | Return to operating room for related procedure during global period | When a related operative procedure is required for a complication during the global period |
79 | Unrelated procedure during global period | When an unrelated procedure is performed during the global period (Note: not in provided list; excluded) |
LT | Left side | When the procedure is performed on the left side (used if laterality reporting is required) |
RT | Right side | When the procedure is performed on the right side (used if laterality reporting is required) |
22 | Unusual procedural services | When the work required is substantially greater than typically required for 38720 due to complexity |
26 | Professional component | When reporting a separate professional component of a service (rare for an operative code like 38720) |
TC | Technical component | When billing only the technical component of a service (not commonly applicable to surgical CPTs) |
50 | Bilateral procedure | When procedure is performed bilaterally and a bilateral modifier is required by payer |
| Taxonomy Code | Specialty | Notes |
|---|---|---|
207R00000X | Otolaryngology (ENT) | Primary specialty performing neck dissections for head and neck malignancy |
207L00000X | Oral and Maxillofacial Surgery | May perform neck dissection when combined with oral cavity resections |
208800000X | General Surgery | Performs oncologic neck dissections in some institutions |
2084P0800X | Surgical Oncology | Surgeon specializing in cancer operations including comprehensive neck dissection |
207K00000X | Plastic and Reconstructive Surgery | Participates when reconstruction or complex soft-tissue work is required |
Related Diagnoses
| ICD-10 Code | Description | Clinical Relevance |
|---|---|---|
C32.9 | Malignant neoplasm of larynx, unspecified | Head and neck squamous cell carcinoma with potential cervical nodal metastasis prompting neck dissection |
C01.9 | Malignant neoplasm of base of tongue, unspecified | Oropharyngeal primary cancers commonly metastasize to cervical lymph nodes |
C02.9 | Malignant neoplasm of other and unspecified parts of tongue | Oral cavity cancers that often require neck dissection for nodal disease |
C06.9 | Malignant neoplasm of oral cavity, unspecified | Primary oral malignancies associated with regional lymph node removal |
C09.9 | Malignant neoplasm of tonsil, unspecified | Tonsillar cancers with cervical nodal involvement managed with neck dissection |
C04.9 | Malignant neoplasm of floor of mouth, unspecified | Floor-of-mouth cancers frequently necessitate cervical lymphadenectomy |
C77.0 | Secondary and unspecified malignant neoplasm of lymph nodes of head, face and neck | Metastatic nodal disease in the cervical region indicating need for 38720 |
Related CPT Codes
| CPT Code | Description | Relationship to This Procedure |
|---|---|---|
31500 | Intubation, endotracheal, emergency or for general anesthesia | Airway management performed prior to 38720 under general anesthesia |
20926 | Tissue transfer, free flap with microvascular anastomosis; head and neck | Performed when extensive reconstruction of the surgical defect follows neck dissection |
38500 | Biopsy or excision of lymph node(s); open, superficial | Performed for diagnostic sampling of individual nodes prior to or instead of a formal neck dissection |
38724 | Radical neck dissection, includes removal of internal jugular vein, sternocleidomastoid muscle, and spinal accessory nerve | Performed in more extensive disease; may be an alternative or extension to 38720 |
36415 | Collection of venous blood by venipuncture | Common ancillary service for preoperative labs and postoperative monitoring |