# sentinel lymph node biopsy followed by lymphadenectomy???



## lbarbar (Mar 25, 2018)

Hello, 

i hope someone will help with this, cause i am really confused. 

if a sentinel lymph node biopsy was done, sent to pathology lab, the result was positive and the doctor decided to do axillary lymphadenectomy (all in the same session). 


how should i code this? 

i have two options:
*1. code only 38745 (Axillary lymphadenectomy; complete) with 38900 (Intraoperative identification (eg, mapping) of sentinel lymph node(s) includes injection of non-radioactive dye, when performed (List separately in addition to code for primary procedure)*
 and not to code the biopsy according to American College of Surgeons
http://bulletin.facs.org/2014/09/frequently-asked-questions-about-coding-for-breast-surgery/
i used this answer as a reference :
When a total mastectomy with sentinel node biopsy is performed, I obtain a frozen section of the nodes and proceed to dissect the axilla if positive. Can I use multiple codes for this procedure?
This is a modified radical mastectomy (19307) with sentinel node mapping procedure (38900). The axillary node biopsy cannot be reported separately from the axillary dissection.


*2. code 38525 (Biopsy or excision of lymph node(s); open, deep axillary node(s)) + 38745 (Axillary lymphadenectomy; complete) with 38900 (Intraoperative identification (eg, mapping) of sentinel lymph node(s) includes injection of non-radioactive dye, when performed (List separately in addition to code for primary procedure)*

according to this article in AAPC: 
If the biopsy is performed on the same lesion on which a more extensive procedure is performed, it is separately reportable only if the biopsy is utilized for immediate pathologic diagnosis prior to the more extensive procedure, and the decision to proceed with the more extensive procedure is based on the diagnosis established by the pathologic examination

https://www.aapc.com/blog/27807-coding-for-biopsy-with-a-related-more-extensive-procedure/ 


i would really appreciate your help


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## jdibble (Mar 27, 2018)

lbarbar said:


> Hello,
> 
> i hope someone will help with this, cause i am really confused.
> 
> ...



The above options are answers for 2 different surgeries. Did the surgeon perform a mastectomy or just the lymphadenectomy? According to your question, there is no mention of a mastectomy - so option number 1 would not apply. If all he did was the lymphadenectomy following the biopsy - then option number 2 would be more appropriate. A modifier 58 would need to be added to 38525.

If I am misunderstanding the procedure, possibly you can post the redacted note.

Jodi


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