Oncology & Hematology Coding Alert

To capture appropriate reimbursement for a sentinel lymph node biopsy, surgical oncology coders need to be familiar with the components of the procedure. Sentinel node biopsies are an increasingly common tool to determine the staging and progression of cancer in oncology patients. Oncologists will biopsy this sentinel node to determine if the cancer has spread or is contained at the primary location. How Is Sentinel Lymph Node Biopsy Performed? The sentinel"" node is the first lymph node to receive drainage from a cancer-containing area of the breast. Sentinel lymph node biopsy involves identification" removal and evaluation of lymph nodes that drain the area of a malignant tumor. Identification of the sentinel node involves complicated coding. Two methods or a combination of both are used to identify a sentinel node:
  Direct visualization of vital dye e.g. isosulfan blue. Direct visualization involves the injection of vital dye shortly before surgery to stain the lymphatic vessels that drain the tumor site which further helps to identify a sentinel node
  Lymphoscintigraphy which is a nuclear medicine procedure that involves injecting a radioisotope such as technetium-99 under the skin hours before surgery. The isotope acts as a radioactive "tracer" as it flows into the sentinel node and its lymphatic channel. Breast Cancer: A Clinical Example During a routine mammogram a lump is found in the right breast of a 64-year-old woman. The mass is biopsied found to be malignant and removed. To determine if the cancer metastasized the oncology surgeon also performs a sentinel node biopsy.

A preoperative lymphoscintigraphy allows the radiologist to assess lymphatic drainage.

A radioactive tracer is injected and the lymphatic system is imaged using a gamma camera. The sentinel node can be marked for the surgeon says Donna J. Richmond RCC CPC of Acadiana Computer Systems Inc. a billing practice management software and services and consulting company based in Lafayette La. The code for this procedure typically submitted by the radiologist is 78195 (Lymphatics and lymph nodes imaging). Richmond clarifies that the hand-held gamma detector is usually used in surgery and would be included in the biopsy code. "78195 includes the injection of a radiopharmaceutical and imaging. If no imaging is done then 78195 is not used and 38792 (Injection procedure; for identification of sentinel node ) would be coded for the injection of the radioactive material."

The cancer site is then injected with isosulfan blue dye to further assist the oncology surgeon in locating the sentinel node. Code 38792 is used to report this service.

According to Richmond a combination of both blue dye and the gamma probe is often [...]