General Surgery Coding Alert

What you need to get paid for lymph excisions in combination with other breast tissue excisions Sentinel node biopsy is not the same as lymphadenectomy, and confusing the two could have dire effects on the accuracy of your claims.
 
Follow these four tips to be sure you-re getting everything your practice deserves from its lymph excision procedures. Tip 1: Include Same-Session Sentinel Excision in Lymphadenectomy You should not separately report sentinel node biopsy (38500-38530) and lymphadenectomy (38700-38780) in the same region during the same operative session. Instead, you should include the sentinel node biopsy in the more extensive, planned, same-location lymphadenectomy.
 
Here's what Medicare says: -Sentinel lymph node biopsy for malignant melanoma is eligible for reimbursement unless a regional lymphadenectomy is planned, regardless of the findings of the [biopsy],- says Empire Medicare Service's local medical review policy (LMRP) for New York and New Jersey (this policy is typical of other Medicare carrier guidelines).
 
Example: The surgeon performs a complete axillary lymphadenectomy (38745) to remove the lymph nodes between the pectoralis major and the pectoralis minor muscles. In this case, the complete lymphadenectomy automatically includes removal of any lymph nodes that would qualify as sentinel nodes (38525, Biopsy or excision of lymph node[s]; open, deep axillary node[s]). You should therefore report 38745 only, in this case. Tip 2: Prior Sentinel Excisions Are Separate When the surgeon performs a sentinel node biopsy prior to an unplanned partial mastectomy (either with or without lymphadenectomy) -- and the subsequent excisions are a result of biopsy findings -- you may report the sentinel node biopsy separately, says Marcella Bucknam, CPC, CCS-P, CPC-H, CCS, CPC-P, charge capture manager at University of Washington Physicians.
 
-This would be billable,- Bucknam says, -just like a breast biopsy is billable when the decision to do the partial mastectomy or other treatment is based on the results of the biopsy.- Specificity Identifies Sentinel Node Biopsy You should consider sentinel node biopsy (38500-38530) to be a more -targeted- procedure than lymphadenectomy (38700-38780), says M. Trayser Dunaway, MD, FACS, CSP, CHCO, a surgeon, physician and coding innovator, and healthcare consultant in Camden, S.C.
 
-Removing the sentinel nodes is a less-invasive procedure,- he says.
 
The sentinel node is the first lymph node to receive drainage from a cancer-containing area of the breast (or other site). The advantage of this technique is that if the sentinel lymph node is negative for metastases, the surgeon need not perform a complete lymphadenectomy (which removes a much greater volume of tissue), thereby avoiding the morbidity and complications associated with that procedure. CMS goes on record: -Sentinel lymph node biopsy is separately reported when performed prior to a localized excision of breast or a mastectomy with or without lymphadenectomy,- according to [...]