General Surgery Coding Alert

Question: What are the rules for reporting multiple sentinel node biopsies?


California Subscriber

Answer: When reporting more than one sentinel node biopsy (38500-38530), you should keep in mind that the number of incisions--not the number of biopsies--determines the number of codes and/or units you should report. Therefore, if the surgeon performs two biopsies through the same incision, you may report only a single code. If the surgeon takes three biopsies from two different incisions, you may report two codes, etc.

When reporting more than one biopsy code, append modifier 59 (Distinct procedural service) to the second and subsequent codes.

Example: Using one incision, the surgeon biopsies a superficial node and a deep axillary node. In this case, because the surgeon accesses the node through a single incision, you may report only the more extensive (higher-paying) code--in this case, 38525 (Biopsy or excision of lymph node[s]; open, deep axillary node[s]).

If, on the other hand, the surgeon performs the same procedures through different incisions, you may report 38525 and 38500, attaching modifier 59 to the lesser (lower-valued) procedure--here, 38500 (- open, superficial)--to indicate a separate anatomic area.