Basics of CPT code 38505 & 38500
A lymph node biopsy is the removal of lymph node tissue for examination under a microscope. The lymph nodes are small glands that make white blood cells (lymphocytes), which fight infection. Lymph nodes may trap the germs that are causing an infection. Cancer often spreads to lymph nodes. CPT code 38505 & 38500 are used for coding lymph node biopsy in medical coding.
We have separate biopsy procedure code for lung, breast biopsy, thyroid, bone biopsy etc. in diagnostic radiology facility. Some of them have even bundled imaging guidance CPT codes as well.
For needle biopsy of lymph node, CPT code 38505 is reported and for open superficial lymph node biopsy, CPT code 38500 is reported.
Read also: When to use Secondary Z codes in ICD 10
Description of CPT code 38505 & 38500 for lymph node biopsy
38505– Biopsy or excision of lymph node(s); by needle, superficial (eg, cervical, inguinal, axillary)
Imaging guidance should be reported separately. Below are the list of imaging guidance codes used along with CPT code 38505
A needle biopsy is in which tissue from deep within the body is obtained by insertion through the skin of a specifically designed needle that detaches tissue with an inner needle so that the tissue can be brought to the surface in the needle’s lumen.
Use CPT code 38525 when Open biopsy or excision of deep axillary lymph nodes or internal mammary nodes is performed. The axillary lymph nodes includes lateral, subscapular, pectoral, central, and apical (infraclavicular) nodes. The central and apical groups are the deep nodes.
Do and Don’t with Procedure code 38505 & 38500
Do not use CPT code 38505 & 38500 when Fine needle aspiration (FNA) is performed, use CPT code 10021 & 10022 for coding FNA. When both Core biopsy and FNA are perfromed, then check the documentation to code them together.
If a FNA biopsy is performed on one lesion and a core biopsy is performed on a separate lesion using the same imaging guidance modality, the image guidance is reported for both lesions, appending modifier 59 to the imaging guidance code for the core biopsy.
Do use imaging guidance CPT code 76942, 77002, 77012, 77021 along with lymph node biopsy CPT codes.
Read also: Best coding tips for Sentinel Lymph node injection
Example . FNA biopsy is performed on a cervical lymph node using US guidance, and a core biopsy is performed on an axillary lymph node using CT guidance.
Coding:
• 10005: FNA using US guidance (FNA cervical node)
• 38505-59: Needle biopsy superficial lymph node (core biopsy axillary node)
• 77012-59: CT guidance biopsy (axillary node)
CPT code +38900 (Intraoperative identification (e.g., mapping) of sentinel lymph nodes) and a new code for vulvar SLN mapping 38531 (Biopsy or excision of lymph nodes, inguinofemoral node) are added from Jan. 1, 2019.
+38900
Intraoperative identification (eg, mapping) of sentinel lymph node(s) includes injection of non-radioactive dye, when performed (List separately in addition to code for primary procedure)
- Can be billed with: 19302, 19307, 38500, 38510, 38520, 38525, 38530, 38531, 38542, 38562, 38564, 38570, 38571, 38572, 38740, 38745, 38760, 38765, 38770, 38780, 56630, 56631, 56632, 56633, 56634, 56637, 56640
- wRVU 2.50 (can be billed bilaterally)
- For example in an endometrial cancer case, correct billing of 38570 Laparoscopy, surgical; with retroperitoneal lymph node sampling (8.49 wRVU) + 38900 (2.50 wRVU x 2) = 13.49 wRVU
38531 Biopsy or excision of lymph nodes, open inguinofemoral node
- Can be billed with +38900 add on code
- Can be billed unilateral or bilateral
- Can be billed at the time of a radical vulvectomy or as a subsequent separate procedure.
- Cannot be billed with more extensive lymphadenectomy codes or any vulvectomy codes that already incorporate lymph node dissection (i.e., 38760, 38765, or 56631-56640).
A new code has also been added that allows us to properly bill for the work performed during a groin dissection for sentinel lymph node biopsy. CPT code 38531 (biopsy or excision of lymph node(s); open, inguinofemoral node(s)) was created as an intermediate code between a simple open biopsy of the lymph node (CPT code 38500) and more complex total lymph node dissections.
The new CPT code 38531 is intended to be used with the 38900 add on code, can be billed for just unilateral lymph nodes or used twice for bilateral lymph nodes. It can be billed at the time of a radical vulvectomy or as a subsequent separate procedure. This code cannot be billed with more extensive lymphadenectomy codes or any of the radical vulvectomy codes that already incorporate lymph node dissection (i.e. 38760, 38765, or 56631-56640).
Sample Code chart of Lymph node biopsy CPT code 38505 & 38500
EXAM: US LYMPH NODE CORE BIOPSY SUPERFICIAL
REASON FOR STUDY: C34.12: MALIGNANT NEOPLASM OF UPPER LOBE, LEFT BRONCHUS OR LUNG, C79.31:
SECONDARY MALIGNANT NEOPLASM OF BRAIN
DIAGNOSIS:
Lung cancer. Lymphadenopathy. Neck lymphadenopathy
CONSENT:
The procedure and possible complications were explained to the patient and written informed consent obtained. Complications include, but are not limited to, bleeding, allergic reactions to injected medications, and infection. While these complications are unusual, they are possible.
MEDICATIONS: None
PROCEDURE/FINDINGS:
Medication reconciliation form reviewed and any changes related to this procedure resolved. Maximal Sterile Barrier Technique utilized. Using sterile technique the area of the left neck was sterilely cleansed draped and anesthetized with buffered 1% lidocaine. Direct ultrasound guidance was utilized. A 19 gauge trocar needles and placed adjacent to the lower left neck lymphadenopathy located between the jugular vein and the carotid artery. Five core samples were obtained and placed in formalin and RPMI solution. The patient tolerated the procedure well. There were no immediate complications.
PERFORMED PROCEDURES:
Ultrasound-guided neck cortical biopsy
MODERATE SEDATION FACE-TO-FACE TIME:
none
IMPRESSION/PLAN: Successful ultrasound-guided left neck core needle biopsy of cervical lymph
adenopathy.
SURGICAL PATHOLOGY REPORT
Clinical Data:
73 year old female; history of lung cancer with left neck lymphadenopathy (KCP,ss)
Gross Description:
Two specimens are received in formalin labeled with the patient’s name and date of birth.
Part 1. Additionally labeled “cores” is a 1.0 cm greatest dimension aggregate of pink-tan soft tissue cores that are entirely submitted in A.
Part 2. Additionally labeled “cores” is a 0.5 cm greatest dimension aggregate of tan-red soft tissue cores that are ÷d into RPMI andcassette B.
The remainder of part 2, in RPMI, is filtered and entirely submitted in C.
Diagnosis:
MICROSCOPIC DIAGNOSIS:
Left cervical lymph node, core biopsy: Metastatic adenocarcinoma;
CPT code: 38505
Biopsy or excision of lymph node(s); by needle, superficial
76942 Ultrasonic guidance for needle placement, imaging supervision and interpretation
ICD10:
C3412 Malignant neoplasm of upper lobe, left bronchus or lung
C7931 Secondary malignant neoplasm of brain
C770 Secondary and unspecified malignant neoplasm of lymph nodes of head, face and neck