Oncology & Hematology Coding Alert

Question: When one of our patients is sent for a sentinel node biopsy, the patient first goes to radiology to have radioactive dye injected. They are then brought to the operating room where the physician identifies the sentinel nodes and before removing them. I have been coding 38525 only per our physician, who says that, as he did not inject the radioactive dye, we should not code for it. Is the physician correct? How should we bill for this procedure?

AAPC Forum Participant

Answer: Your physician is correct in that he should not be reimbursed for the radioactive dye injection. That should be billed by the radiologist using 38792 (Injection procedure; radioactive tracer for identification of sentinel node). But you are both incorrect in only coding 38525 (Biopsy or excision of lymph node(s); open, deep axillary node(s)). That code is solely for the excision, and you should also be coding for the mapping.

This is where the confusion lies. The wording of the mapping add-on code, +38900 (Intraoperative identification (eg, mapping) of sentinel lymph node(s) includes injection of non-radioactive dye, when performed (List separately in addition to code for primary procedure)), says that the procedure “includes injection of non-radioactive dye, when performed” (emphasis added). The non-radioactive dye injection is a non-essential component of the procedure, meaning you can use this code for the mapping whether or not non-radioactive dye is injected.

So, you should code 38525 with +38900 to reflect the full scope of the procedure — the mapping and the excision — your provider performs. This reflects the instructional note accompanying +38900, which lists 38525 as one of the primary procedures with which you can report the add-on code. The note also adds that you would use 38792 for the injection of radioactive tracer if your physician performed the injection. But be aware that 38792 is a column 2 code for +38900, though a modifier is allowed to bypass the edit if and when performed and supported by documentation.