38500

Biopsy or excision of lymph node(s); open, superficial

CPT code 38500 describes an open surgical procedure performed to obtain a biopsy or complete excision of one or more superficial lymph nodes. Superficial lymph nodes are those located within the subcutaneous tissue, typically in the cervical (neck), axillary (armpit), or inguinal (groin) regions, and do not require deep dissection beneath the muscle fascia or into body cavities. The procedure begins with the patient being appropriately positioned and the surgical site being prepared and draped in a sterile fashion. Depending on the patient's condition and the node's location, local anesthesia with sedation or general anesthesia is administered. The surgeon makes a skin incision directly over the palpable or radiographically identified lymph node. Using both blunt and sharp dissection, the surgeon navigates through the subcutaneous fat to isolate the lymph node. Care is taken to avoid injury to adjacent nerves and major blood vessels. Small feeder vessels to the node are ligated or cauterized to maintain hemostasis. Once the node is fully mobilized, it is removed in its entirety (excision) or a portion is taken (biopsy). The specimen is then typically sent for histopathological, cytological, or microbiological analysis to diagnose conditions such as lymphoma, metastatic cancer, or chronic infections like tuberculosis. After ensuring the surgical field is dry and free of bleeding, the surgeon closes the incision in layers, usually involving a subcutaneous layer and a skin closure with sutures, staples, or adhesive strips. This code is specifically reserved for nodes that are easily accessible and located in the superficial tissues.

Clinical Indications

  • Unexplained persistent lymphadenopathy
  • Suspected primary malignancy such as Hodgkin or Non-Hodgkin lymphoma
  • Evaluation for metastatic spread from a known primary tumor
  • Suspected granulomatous disease such as sarcoidosis
  • Investigation of chronic infectious processes (e.g., tuberculosis, cat-scratch disease)
  • Staging of known malignancies
  • Failure of needle biopsy to provide a definitive diagnosis

Procedure Steps

  1. Position the patient to provide optimal access to the target lymph node site.
  2. Administer anesthesia (local with MAC or general anesthesia).
  3. Perform sterile preparation and draping of the operative area.
  4. Perform a skin incision over the site of the palpable or localized lymph node.
  5. Dissect through the subcutaneous tissue layers to identify the target node.
  6. Carefully isolate the node from surrounding connective tissue and neurovascular structures.
  7. Ligate or cauterize small blood vessels supplying the node to ensure hemostasis.
  8. Excise the entire lymph node or take an adequate biopsy sample.
  9. Irrigate the wound with sterile saline to check for further bleeding.
  10. Close the wound in layers using absorbable sutures for deep layers and sutures or staples for the skin.
  11. Apply a sterile dressing to the incision site.
  12. Submit the specimen to the pathology department for analysis.

Coding Guidelines

  • Report 38500 for superficial lymph nodes located in the subcutaneous fat.
  • For deep cervical nodes, use code 38510 instead of 38500.
  • Do not report 38500 if the biopsy is performed percutaneously; see 38505 for needle biopsy.
  • If multiple nodes are removed through the same incision, 38500 is generally reported only once.
  • If nodes are removed from separate anatomical sites (e.g., neck and groin), use modifier 59 or XS for the second site.
  • If the procedure is performed bilaterally, append modifier 50.
  • This code should not be reported separately when the lymph node excision is an integral part of a larger procedure, such as a radical neck dissection or a mastectomy.
  • Check NCCI edits to ensure bundling compliance with other surgical procedures performed in the same session.

Associated ICD-10 Codes