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Tip: Understand sentinel nodes

Ambulatory Surgery Reimbursement Update, October 21, 2008

The sentinel node is the first lymph node in a chain of lymph nodes (called the lymphatic basin) that receives lymphatic fluid, which drains from the site of a malignant tumor. It assists in the accurate staging of cancers that have spread to the lymph nodes.

Biopsies or excisions of sentinel nodes do not have special CPT codes that differ from regular lymph node codes. Code them from CPT section 38500–38564 for an open lymph node biopsy or excision of a lymph node(s).

Use CPT code 38792 for the injection procedure to identify a sentinel node and code 78195-TC for related imaging (when billable). Note that surgeons rarely perform this procedure in an ASC. However, when surgeons perform the node excision only and do not inject the dye or radiopharmaceutical tracer, you should bill only using the applicable code from the 38500–38542 code range.

Do not bill separately for a sentinel node biopsy performed during the same operative session as an axillary node dissection. When a surgeon performs biopsies of two sentinel nodes during the same operative session through different incisions, bill both using the appropriate codes and append modifier -59 to the second CPT code.

Code axillary lymphadenectomy procedures based on the detailed documentation of the depth of the excised lymph nodes. Use CPT code 38740 for superficial excisions and code 38745 for complete excisions. (In a complete excision, surgeons remove most or all of the lymph nodes in the area). Use the code 38745 only when the operative report documents that the surgeon entered the muscle and removed deep lymph nodes in addition to removing superficial lymph nodes.

Do not use code 19302 (partial mastectomy with axillary lymphadenectomy) when a surgeon removes only a few lymph nodes. Instead, report that code only when a surgeon removes a significant number of lymph nodes during the mastectomy procedure.

This tip is brought to you by Ellis Medical Consulting, Inc.

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