General Surgery Coding Alert

Question: If the surgeon performs a partial mastectomy and an open axillary sentinel lymph node  excision of three nodes, should I code this as 19302 or 19301 plus 38525? New York Subscriber Answer: You should code the partial mastectomy as 19301 (Mastectomy, partial [e.g., lumpectomy, tylectomy, quadrantectomy, segmentectomy). You should separately code the sentinel lymph node biopsy using the appropriate code based on the depth of the nodes, such as 38500 (Biopsy or excision of lymph node[s]; open, superficial). Here's why: You should not list 19302 (... with axillary lymphadenectomy) for the service because a lymphadenectomy describes a regional lymph node resection, not excision of one or a few specific sentinel nodes. Caveat: If the surgeon removes a sentinel node, then it returns positive for metastasis and the surgeon goes on to perform a lymphadenectomy in the same operative session, you should not separately bill the sentinel node biopsy. In [...]