# 19301 or 19302



## codedog

Stuck on ths one .

dx- breast carcinoma
operation- right lumpectomy with sentinel node

Procedure in detail - 
   Patient was taken to operating room, underwent general anesthesia. The patient had received nuclear medicine injection yesterday at 5 0-clock. Lymphazurin blue was placed 3 cc in a periareolar fashion. The breast  was massaged for 5 min  to ensure  adequate lympathic drainage of the area.  First incision was given to the axilla. The Neophrobe was used and the anterior axillary hairline  was oincised for 2 cm and taken down through skin and subcutaneous tissue., After dissection  for about 5 or 10 min, a blue node could be found, 2 or 3 blue lymph nodes, clearly lit up with the Neoprobe . This was excised and dent to pathlogy. The area was irrigated and closed in two layers with 3-0 VICRYL and 4-0 Vicryl in subcuticular  fashion. Next, attention at breast, the previous incision. An illiptical incision was made including the previous scar with surrounding tissue. This was around 9 cm. It was takken down to 8 to 9 cm through shin and subcutaneous tissue. The cavity was not entered and all surrounding tissue was removed. It  was labeled for pathologists with marking sutures. The wound was closed in 2 layers with  3-0 vICRYL IN SUBDERMAL LAYER AND 4-0 vicryl in subcuticular fashion. 

Path report came back as  three  of  seven  axillary nodes  postive for  metastatic carcinoma and infiltrating ductal carcinoma and widespread ductal 
carcinoma in situ. 

WOULD YOU CODE 19301 WITH 38525, OR DO YOU JUST CODE 19302?


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## pkidd

Greetings,

I would use CPT 19302.  The lymph nodes were removed via a separate incision.  To my knowledge, we've not had a denial by coding it this way.  FYI: We also add CPT 38792 with modifier -77 for the administration of the lymphazurin.
Hope this is helpful,
Pat Kidd
pkidd@samhealth.org


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## codedog

OK, but why not 19301 and 38525 ?


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## codedog

Now someone else told me to use 19120 with 38525 , now  i am confused


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## codedog

what is the diffrence between 19120 and 19301 , and 19302


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## mmelcam

19120- They remove the mass with no attention to margins
19301- They remove the mass with margins
19302- They remove the mass with margins and also remove lymph nodes between the pectoralis major muscles and the pectoralis minor muscles and the nodes in the axilla are removed.

This information is per my coder's desk reference book.

I would code this case as 19301 & 38525.


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## mizzmaryb

i know i'm 3 months behind but i was also looking up info of 19301 vs 19302 and posting 38525/38745.

I keep reading you would code 19302, if not a complete axillary lymphadenectomy and contents were done AND if it was done a *separate *incision.

You would code 19301 if the lymph nodes were taken through the *same *incision.

Can i get more explanation on this? Where would i find this? And, i'm seeing two different answers on this thread. You have one person wanting to code out a 19302 and another 19301.

???


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## rsboggs

mizzmaryb said:


> i know i'm 3 months behind but i was also looking up info of 19301 vs 19302 and posting 38525/38745.
> 
> I keep reading you would code 19302, if not a complete axillary lymphadenectomy and contents were done AND if it was done a *separate *incision.
> 
> You would code 19301 if the lymph nodes were taken through the *same *incision.
> 
> Can i get more explanation on this? Where would i find this? And, i'm seeing two different answers on this thread. You have one person wanting to code out a 19302 and another 19301.
> 
> ???



Our office also does the 19301 in conjunction with the 38525 and 38792 for our WLE with sentinel lymph node biopsy and injection for identification of the sentinel node. We have not been denied billing it this way. We were originally billing the 19302, but I found a very good article in The Journal of Family Practice about the right way to bill for sentinel nodes. it states:

ANSWER: The American College of Surgeons and Medicare addressed this coding scenario. CPT code 19302 describes a partial mastectomy-a lumpectomy, tylectomy, quadrantectomy or segmentectomy with axillary lymphadenectomy. 

For Partial mastectomy (CPT 19301) with sentinal lymph node biopsy (typically CPT code 38525) and dye injection to identify the sentinel node (CPT code 38792) the surgeon would use these CPT codes to report the service.
*19301
*38525-51
*38792 (a modifier 51 exempt code)

_There reasoning behind this being "bundling this procedure into CPT code 19302, which describes an axillary lympadenectomy, is incorrect. That is not what the surgeon performed. While the facility may feel the reimbursement is better by reporting 19302, the physician must accurately report the CPT codes to describe the procedure regardless of reimbursement"_


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