# methylene blue injection during mastectomy



## terese74 (Nov 20, 2007)

does anyone know if there is a code for injecting methylene blue into the breast for lymph node localization during a mastectomy? or is this included in the procedure? THanks for any help!


----------



## kevbshields (Nov 21, 2007)

Methylene blue is basically a dye; it is included in the surgical code describing the operative session.


----------



## mmelcam (Nov 24, 2007)

Look at 38790 or 38792. We use these codes but your physician has to be the one doing the injection, not radiology, in order to bill these codes.


----------



## kevbshields (Nov 26, 2007)

Before using 38790 and 38792, please note that methylene blue is not a radiopharmaceutical--thus making 38790 inapplicable for this injection.  

CPT Asst., Nov. 1998 does a good job of explaining 38792--which is used for "radioactive injection(s)".

Methylene blue is used in surgeries to visually trace the lymphatics and identifying/creating appropriate planes for excision; it is does not relate to the code mentioned above as those are specific to other services.


----------



## cmartin (Feb 6, 2008)

If you're also billing for the sentinel lymph node bx, as with a 19301 or 19303 you might be billing a 38525, then I believe 38792 is appropriate-it just reads "Injection procedure;for identification of sentinel node".  I've never heard that it had to involve anything radioactive.
C.Martin
CPC-GENSG


----------



## sundaey (Mar 6, 2008)

I have been using 38792 for my injection procedure to ID the lymph nodes. Especially if they the are not extensive. But, if the doc removes all of the axillary lymph nodes during mastectomy, then I would use the code that has both.


----------



## kevbshields (Mar 8, 2008)

Read the descriptors in the Ingenix Coder's Desk Reference for CPT.  This may clear up any potential inappropriate use of the code set.


----------



## dparker19 (Mar 10, 2008)

What about 38792?


----------



## cmartin (Mar 14, 2008)

Our Medicare B Carrier, National Govt Services, just released sentinel lymph node policy, Article A47181, which states that 38792 is appropo for the surgeon injecting dye AND/OR other substances for ID of sentinel node.
"CPT code 38792 can be billed for both the injection of radioactive tracer when performed without lymphoscintigraphy; and for the injection of vital dye (Isosulfan Blue Dye or a similar product) to visualize the sentinel node, by the surgeon/physician who performs the injection." [I cut and pasted that line from the article on the NGS website]
Connie Martin
CPC-GENSG


----------

