Neck Dissection

Clinical Indicators
Neck Dissection

Procedure	CPT	FUD
Radical lymphadenectomy*
Suprahyoid	38700	90
Cervical	38720	90
Modified RND	38724	90

*Note: Neck dissection performed in conjunction with removal of a primary malignancy is coded with the primary, i.e., laryngectomy with radical neck dissection is CPT 31365 and ICD-9 30.4

Indications
1. History... one or more required

a)	Primary head and neck malignancy proven by biopsy or prior surgery (required).
b)	Enlarging (usually non-tender) neck mass with history of regional primary malignancy.
c)	Use of tobacco and alcohol.
d)	Neck mass malignancy proven by biopsy or fine-needle aspiration but no primary site identified.

2. Physical Examination... required

Comprehensive examination of the head and neck with emphasis on:
a)	Description of neck mass and clinical staging.
b)	Description of head and neck primary site, if known.

3. Tests... required

a)	Pathologic confirmation of primary site or in case of unknown primary, confirmation of neck mass malignancy.
b)	CT Scan or MRI of head and neck (optional).

Postoperative Observations

1.	Wound infection.
2.	Bleeding.
3.	Wound breakdown.
4.	Fistula.
5.	Chylous leak.
6.	Function of VII, X, XI, XII cranial and brachial plexus.
7.	Electrolyte balance and blood volume determination.
8.	Adequate respirations.
9.	Drains--document if functional or removed.
10.	Pneumothorax.

Outcome Review
1. One Week

a)	Review chart for topics listed above, under "postoperative observations."
b)	Is patient able to return to normal daily activity?
c)	Recommendations made following review of pathological findings including adjuvant therapy.

2.Beyond One Month

a)	Tumor status--Any evidence for residual or recurrent tumor?
b)	Functional assessment--Is patient able to return to work? Are there any restrictions? Assess need for physical therapy.
c)	Cancer registry---Is case being followed by local tumor registry, institution or surgeon for long-term survival studies?
d)	Long-term follow-up by surgical oncologist.

Associated ICD-9 Diagnostic Codes

196.0	Secondary and unspecified malignancy of lymph node (primary unknown)
198.89	Secondary malignant neoplasm of other specified sites, other
199.0	Malignant neoplasm without specification of site, disseminated
199.1	Malignant neoplasm without specification of site, other

Additional Information
Assistant Surgeon -- Y
Supply Charges -- N
Prior Approval -- N

Anesthesia Code(s)
00300, 00320, 00322

Patient Information

Neck dissection is performed in order to remove known or suspected lymph nodes containing cancer. Its purpose is to prevent further spread of that disease to other parts of the body. Over the past 50 years it has proven to be an effective method of head and neck cancer control. Complications of this surgery include wound infection and breakdown, bleeding, leakage of lymph fluid, injury to nerves controlling the lower face, throat, shoulder, tongue, diaphragm, and skin sensation under ear and jaw. Undesired effects can include shoulder weakness and pain in the neck. Most patients who have only a neck dissection are able to return to normal daily activities after healing.

Important Notice

The Clinical Indicators for Otolaryngology--Head and Neck Surgery are guidelines only. In no sense do they represent a standard of care. The applicability of an indicator for a procedure, and/or of the process or outcome criteria, must be determined by the responsible physician in light of all the circumstances presented by the individual patient. Adherence to these guidelines will not ensure successful treatment in every situation. The American Academy of Otolaryngology-Head and Neck Surgery, Inc. emphasizes that these clinical indicators should not be deemed inclusive of all proper treatment decisions or methods of care, nor exclusive of other treatment decisions or methods of care reasonably directed to obtaining the same results.