Radiology Coding Alert

Question: If the physician performs multiple injections for a single sentinel node in a single breast, how many units of 38792 should I report?

Indiana Subscriber

Answer: The answer depends on whether you're referring to multiple injections of a single substance (one line item, one unit) or injections of two separate substances (two line items, one unit each), according to National Government Services (NGS), your Medicare Part B administrator for Indiana.

Two substances: The performing physician may report 38792 (Injection procedure; for identification of sentinel node) "for both the injection of radioactive tracer when performed without lymphoscintigraphy; and for the injection of vital dye (Isosulfan Blue Dye or a similar product) to visualize the sentinel node," states NGS article A47181. (You can search for the NGS article at www.cms.hhs.gov/mcd/overview.asp.)

How: If a single physician performs and reports both the tracer injection and the dye injection, you should bill two line items and append modifier 59 (Distinct procedural service) to the second item, the NGS article states. You should report a single unit for each line item of 38792 "regardless of the number of injections for each substance," the article adds.

One substance: As the instruction for multiple substance reporting indicates, you should report a single unit even if the radiologist performs multiple injections of a single substance. You may see four injections around the tumor, for example.

Term tip: The sentinel node is the first in the chain of lymph nodes receiving lymphatic fluid draining from the tumor site. A biopsy to identify cancer cells in the node helps in staging and determining metastasis. The dye and/or tracer injections help the physician locate the node.

Remember that if you are performing lymphoscintigraphy (lymph node imaging), you should report 78195 (Lymphatics and lymph nodes imaging), not 38792. Report 38792 only if no imaging service is performed.

Caution: Be sure to check other payers for their rules on whether (and how) to report the dye and tracer injections separately.

-- The answers for You Be the Coder and Reader Questions were reviewed by Michele Midkiff, CPC-I, PCS, RCC, executive director of Coding Affiliates Inc., an interventional and neuro-interventional radiology coding service in Mountain View, Calif.