# need help with lymph node dissection



## kingkong (Jul 27, 2010)

Pt. had left axillary sln bx with frozen section, converted to full axillary lymph node dissection and bilateral mastectomy.  Can I bill for sln bx, which showed met. ca and then full axillary ln dissection with a 58 mod.? If so, what code would I use for the full ln dissection?


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## deborahcook4040 (Jul 27, 2010)

When you say "converted", did this all happen during the same operative session? If so, then I think the inital biopsy would be included with the rest of the procedure. Also, modifier 58 would be inappropriate.

If the double mastectomy happened during a seperate procedure, then a modifier 78 would be more appropriate than a 58, unless they knew it was malignant before they did the initial biopsy and had the second surgery scheduled, which seems unlikely.


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## kingkong (Jul 27, 2010)

yes, this all took place during the same op session. Pt had rt. breast ca and breast conservation surgery last yr, followed by radiation.  This yr. her mammo showed a new change on the left side which turned out to be an invasive ca.  Pt was scheduled for bilateral mastectomy and lymph node staging on the left.  The frozen section showed the metastatic ca. 
So you feel that I can only bill for sln bx and bilateral mastectomy?


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## deborahcook4040 (Jul 27, 2010)

It should be a bilateral modified radical mastectomy (or bilateral radical mastectomy, if he took the muscle). 19306 includes the pectoralis major and minor and all axillary and internal mammary lymph nodes. 19307 includes all axillary lymph nodes, but excludes the pectoralis major. With this code, any lymph nodes not considered axillary could be billed seperately with a modifier 51.


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## kingkong (Jul 27, 2010)

Thank you


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