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General Surgery Coding Alert

Reader Question:

No Fee Schedule Yet for Sentinel Node Code

Published on Wed Mar 01, 2000

Question: In the December 1999 General Surgery Coding Alert on page 41, code 38792 for identification of sentinel node was discussed. I have checked my Medicare fee schedule and there is no listing for 38792, just 38790 (injection procedure; lymphangiography). Perhaps you know the limiting charges and non-participating fees?

Anonymous Oregon Subscriber

Answer: In the January 1999 Medicare bulletin issued by the carrier in your state, you will find a list of procedures for which Medicare does not yet have a fee schedule. You are correct: 38792 (injection procedure; for identification of sentinel node) is one of the codes on that list, says Kathleen Mueller, RN, CPC, CCS-P, an independent general surgery coding specialist in Lenzburg, Ill. The bulletin goes on to state, however, that providers should go ahead and bill the 38792, wait for the denial and then forward the operative report because this report has a mandated review prior to payment.
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