Radiology Coding Alert

Question: How should I code for a sentinel node injection performed four times in each breast?

Georgia Subscriber

Answer: If there are separate and distinct injections for each of the individual nodes, code for each injection using modifier -59 (Distinct procedural service). If there are multiple injections for one node, report the injections only once per node. If one injection is used to localize multiple nodes, the service is coded only once without regard to the number of nodes localized.
 
The code for sentinel node injection is CPT 38792 (Injection procedure; for identification of sentinel node). This particular code is modifier -51 (Multiple procedures) exempt, according to the CPT manual . But if the physician is identifying more than one sentinel node at this time, append modifier -59 to the second and subsequent times you report 38792 for each set of injections related to one node.
 
Example: Your physician performs four injections in the left breast for one sentinel node and four injections in the right breast for one sentinel node. You report 38792, 38792-59.
 
Don't forget 78195 (Lymphatics and lymph nodes imaging) if this nuclear medicine service is involved.