General Surgery Coding Alert

Question: When our surgeon performs 19301 or 19303, she wants to additionally bill +38900 for using dye for a sentinel lymph node biopsy. Can we do this, even though CPT® doesn't list 19301 or 19303 as one of the base codes for add-on code +38900?

Minnesota Subscriber

Answer: If your surgeon documents injecting dye to identify the first-draining node(s) in the lymph node basin, then removing a sentinel lymph node based on the findings, you can report that work in addition to a mastectomy.

The base code for the sentinel lymph node biopsy is one of the following, depending on the approach and the node(s) location:

• 38500 -- Biopsy or excision of lymph node(s); open, superficial
• 38505 -- ... by needle, superficial (e.g., cervical, inguinal, axillary)
• 38525 -- ... open, deep axillary node(s)
• 38530 --... open, internal mammary node(s).

You can list +38900 (Intraoperative identification [e.g., mapping] of sentinel lymph node(s) includes injection of non-radioactive dye, when performed [List separately in addition to code for primary procedure]) with any of the lymph node biopsy codes as a base code when your surgeon documents the work.

Code mastectomy: You should also bill for the mastectomy, which you stated was either 19301 (Mastectomy, partial [e.g., lumpectomy, tylectomy, quadrantectomy, segmentectomy]) or 19303 (Mastectomy, simple, complete).

Caution: If your surgeon is actually performing a partial or modified radical mastectomy that includes lymphadenectomy, you should not be using 19301 or 19303. Instead, you should code 19302 (Mastectomy, partial [e.g., lumpectomy, tylectomy, quadrantectomy, segmentectomy]; with axillary lymphadenectomy) or 19307 (Mastectomy, modified radical, including axillary lymph nodes, with or without pectoralis minor muscle, but excluding pectoralis major muscle).

These also serve as base codes for +38900, which you can report in addition to 19302 or 19307 if the surgeon performs the lymph node mapping to identify the sentinel node(s) before completing the axillary lymphadenectomy.