Radiology Coding Alert

Question: If our physician injects radioactive tracer for a sentinel node biopsy and then the surgeon uses a handheld gamma detector for locating the node, how should we report our physician's services?

Texas Subscriber

Answer: For your physician's services, you should report only 38792 (Injection procedure; for identification of sentinel node).

You also would report 38792 if your physician performed the injection and used the handheld gamma detector. If on the other hand your physician performed a sentinel node injection with lymphoscintigraphy (using a gamma camera for real-time imaging), you should report 78195 (Lymphatic and lymph nodes imaging) and leave 38792 off the claim.

Take note: The Medicare physician fee schedule splits 78195 into professional and technical components, so if you're reporting only the physician's services, you should append modifier 26 (Professional component). Code 38792 is designated as a physician service code, meaning it does not have professional and technical components. You should not append modifier 26 (or modifier TC, Technical component) to 38792.