# Inguinal Sentinel Node Biopsy



## jlb0807 (Jan 27, 2014)

Hello All!

Does anybody know if there is a code for an inguinal sentinel node biopsy? If not, is 38510 appropriate?

Thanks,
Jessica


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## Amy Pritchett (Jan 27, 2014)

*Reply to Sentinel Node Question*

Jessica, 
To answer your quesion, yes there are two. You failed to post in your question if the entire lymph node was removed or if the node was biopsied. I will give you both codes:

For biopsy of inguinal sentinel node, the code would be 38999. There is not a specific CPT code for inguinal sentinel node.


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## jlb0807 (Jan 27, 2014)

Amy,

My bad! Yes, the entire thing was removed. Lymph nodes always confuse me for some reason. Thanks for your help!


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## jharo1733 (Jan 27, 2014)

Without knowing the depth from which the SLN were taken from, how are you coming up with unlisted CPT 38999?  SLN can be located both superficially and deep.  This would depend on what is documented in the operative report.  38500 if superficial, 38999 if deep


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## jlb0807 (Jan 27, 2014)

The op note says:

The incision was carried down toward the subcutaneous tissues and cautery bovied. The anterior fascia was opened and it was obvious that there was a large blue node easily identified with the lymphatic channels leading to it. The en vivo counts were in between 257 and 563 range. This was dissected using Bovie cautery. Medium hemoclips were placed for hemostatis, being aware of the surrounding neurovascular structures. This node was completely dissected and ex vivo count was about 454 with a residual bed count of 2 to 3 confirming removal of sentinel lymph node.

I'm thinking deep since it's down to the fascia, so 38999?


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## jharo1733 (Jan 28, 2014)

Not necessarily.  In order to get to either "superficial" or "deep" lymph nodes, fascia has to be incised to reach them.  For example, "superficial" lymph nodes are located below Camper's fascia (these are where the majority of inguinal LNs are located).  "Deep" lymph nodes are located below cribriform fascia. 

I am attaching a link for you to review in regarding to the anatomy of this region and relationship of the lymph nodes

http://ic.steadyhealth.com/inguinal_lymph_nodes.html


Based on the documentation that is provided, I would code this as 38500.  I do not see the documentation to substantiate coding this  as a "deep" excisional bx.

Also, speak to your physician about being specific on the type of fascia as this will affect on how these procedures are coded 

_Judy A. Haroon, RN, BSN, CPC, CGSC, AHIMA ICD-10 Approved Trainer_


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## jlb0807 (Jan 28, 2014)

Great, thanks for the link and for your help


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