38505

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

CPT 38505 describes a percutaneous needle biopsy of a superficial lymph node. This procedure is typically performed on nodes located just beneath the skin in regions such as the neck (cervical), armpit (axillary), or groin (inguinal). It differs from deeper biopsies which involve open surgical incision and dissection. The procedure involves the use of a fine-gauge or core needle to extract tissue or fluid for cytological or histological examination. Imaging guidance, such as ultrasound, is frequently utilized to ensure precise needle placement, although imaging is coded separately. This is a diagnostic procedure primarily used to evaluate lymphadenopathy, suspected primary malignancy such as lymphoma, metastatic disease from other primary sites, or inflammatory/infectious processes like sarcoidosis or tuberculosis. The procedure is typically performed in an outpatient setting or office under local anesthesia. After identifying the node via palpation or imaging, the physician cleans the skin with an antiseptic and inserts the biopsy needle directly into the lymph node to obtain a specimen. Multiple passes or 'cores' may be required to ensure that the tissue sample is adequate for the pathologist to render a definitive diagnosis. Pathological evaluation is a critical secondary step to this procedure. This specific code is designated for 'superficial' nodes; deeper nodes or those requiring open surgical excision involve different codes such as 38510 or 38500. Because it is a needle-based procedure, the recovery time for the patient is minimal, and the risk of complications such as hematoma or infection is significantly lower than that associated with open surgical biopsy techniques.

Clinical Indications

  • Persistent or unexplained superficial lymphadenopathy
  • Suspected lymphoma (Hodgkin or Non-Hodgkin)
  • Staging of known malignancy (e.g., breast cancer, melanoma)
  • Investigation of systemic inflammatory conditions like sarcoidosis
  • Evaluation of chronic infections or granulomatous disease
  • Monitoring response to chemotherapy or radiation in known cancer patients
  • Palpable mass in the neck, axilla, or groin regions

Procedure Steps

  1. Identify and localize the target superficial lymph node through palpation or imaging guidance.
  2. Position the patient to provide optimal access to the biopsy site.
  3. Prepare the skin with an antiseptic solution (e.g., chlorhexidine or povidone-iodine).
  4. Administer local anesthetic (e.g., 1% lidocaine) to the skin and subcutaneous tissues overlying the node.
  5. Make a small nick in the skin if a core needle is used to facilitate entry.
  6. Insert the biopsy needle (fine needle or core needle) into the lymph node.
  7. Obtain tissue or fluid samples using suction (FNA) or a spring-loaded mechanism (core).
  8. Confirm the adequacy of the specimen (may involve on-site cytology).
  9. Withdraw the needle and apply direct pressure to the site to achieve hemostasis.
  10. Apply a sterile dressing or bandage.
  11. Label and transport the specimen to the pathology laboratory for analysis.

Coding Guidelines

  • Report 38505 for needle biopsy of superficial lymph nodes only.
  • If imaging guidance is used, it should be reported separately (e.g., 76942 for ultrasound guidance, 77012 for CT guidance).
  • If a fine needle aspiration (FNA) is performed instead of a core biopsy, refer to codes 10021 or 10004-10012; however, 38505 is often used for core needle biopsies of lymph nodes.
  • Do not use 38505 if an open excisional biopsy is performed; use 38500 (superficial open), 38510 (deep cervical), or 38520-38530 for other deep sites.
  • For needle biopsy of deep lymph nodes (e.g., retroperitoneal or mesenteric), refer to code 49180.
  • If multiple nodes are biopsied at different anatomical sites, append modifier 59 or XS to the subsequent codes if appropriate.

Associated ICD-10 Codes