Proper Coding Ensures Optimal Reimbursement For Lymphoscintigraphy
Published on Tue Aug 01, 2000
Sentinel node biopsies are becoming an increasingly common tool to determine the staging and progression of cancer in oncology patients throughout the country. In many instances, lymphoscintigraphy a nuclear medicine imaging and localization procedure that often accompanies sentinel node biopsies is performed. Yet many radiology coders express confusion about the appropriate way to report this service.
At the core of the confusion are two codes used to describe lymphoscintigraphy: CPT 78195 (lymphatics and lymph glands imaging) and 38792 (injection procedure; lymphangiography; for identification of sentinel node). Each is assigned in distinct and clearly defined circumstances. But the two cannot be reported together by the same physician.
The confusion is exacerbated when coders realize that, sometimes, the nuclear radiologist performs the injection of the radioisotope, but does no imaging. Instead, the surgeon reads the progression of the radioactive material through the lymphatic system in the operating room with special Geiger counter-type instruments. And, in other situations, the surgeon can report the injection code, if he or she uses special dyes to help visualize the targeted node.
Use Code 78195 for Entire Imaging Procedure
According to Kenneth McKusick, MD, FACR, who is retired from the Massachusetts General Hospital and now a member of the American Medical Association CPT Advisory Committee representing the Society of Nuclear Medicine, lymphoscintigraphy is performed on patients who have had a tumor biopsy or lesion excision that confirms the presence of cancer. Surgeons and oncologists often then will conduct a sentinel node biopsy to find out if the cancer has spread or metastasized, he explains.
A sentinel node is described as the first node in the lymphatic network that drains lymphatic fluid from a tumor site. As a general rule, the lymphatic system cleanses the bodys tissues by draining and transporting fluid from the tissues back to the blood. If one or more malignant cells from a primary tumor site migrate into the lymphatic network, they usually lodge in the node closest to the site. Oncologists will biopsy this sentinel node to determine if the cancer has spread or is contained at the primary location.
Lymphoscintigraphy is used to help the surgeon map the lymphatic network emanating from the tumor site and locate the sentinel node, McKusick explains. During lymphoscintigraphy, the nuclear radiologist injects a radionuclide under the patients skin in the region of the malignant tumor or lesion. This tracer takes approximately 15 to 30 minutes to flow toward and into the sentinel node.
Then, using a gamma camera, the nuclear radiologist obtains dynamic, real-time images to localize the specific sentinel node that needs to be biopsied. A map will be drawn directly on the patients skin to indicate where the sentinel node is positioned. In [...]
