# ICG during DaVinci hysterectomy for lymph nodes



## Kelly_Mayumi (May 26, 2017)

Has anyone encountered injection of ICG dye for sentinel lymph node identification preformed during a robotic hysterectomy?  https://www.youtube.com/watch?v=fY5cCexFZyY


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## csperoni (Jul 3, 2017)

*Unfortunately unlisted 38999*

Well, a little late, but I have a lot of experience with this.  The daVinci sentinel lymph node mapping is frequently done during a daVinci laparoscopic hysterectomy for endometrial cancer patients.  You would code the lap hyst (58570-58573 depending on size of uterus and whether or not ovaries/tubes were removed), lap lymph nodes (38570), and for the sentinel lymph node mapping itself (unlisted 38999).  
Be advised CPT 38900 is the exact description of what is actually done (intraoperative identification of sentinel lymph node(s) includes injection of non-radioactive dye, when performed).  Unfortunately, 38900 is an ADD ON code.  The only base codes as primary for 38900 are BREAST surgery codes.  So I bill 38999 and ask it to be valued as 38900.  As we all know, unlisted codes take forever and at least 1 appeal letter to get paid.  I have tried billing 38900 since that is really what is done.  Most insurances will deny as no base code (United HC, Oxford, GHI, Medicare, MagnaCare, Affinity), so those get billed 38999 from the start.  Two carriers (Local 1199 and CareConnect) will pay 38900 WITHOUT the required base code.  BCBS will sometimes pay 38900 and sometimes deny, in which case I will rebill as 38999.

Although tempting, you cannot use 38792 (injection procedure; radioactive tracer for identification of sentinel node) as the ICG dye is not radioactive.  

I have been in correspondence with the Society of Gynecologic Oncologists regarding this issue.  It is my understanding they will be attempting to get additional base codes eventually added to 38900.  I also know of several offices that just don't bother billing for the mapping.  I am not of that mindset since it is additional work and the physician should be reimbursed as such.     

Good luck!


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## csperoni (Feb 11, 2019)

*38900 updated*

Since I posted this answer in 2017 & I know people often reference previous posts, I thought it important to update my answer.
38900 add on code is now billable with 38570-38572 for the laparoscopic lymphadenectomy as of 2019.  You no longer need to use unlisted 38999.

Of important note - 38900 can be billed with -50 if done bilaterally.  I know my provider typically does an injection at 3 o'clock and 9 o'clock.


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