Wiki Mastectomy with sentinel lymph node

[Trendale]

Can someone tell me if a sentinel lymph node bx is bundled with the mastectomy or is it a separate payment?. It is the same incision site, do I code it separate with a 59?

 

[efrohna]

Letisha, it depends on the planned procedure.

Example of when to bill both: The planned procedure was mastectomy, partial, SLN bx returns from pathology as malignant. (Results changed the planned procedure to mastectomy w/axilllary lymphadenectomy).
Remember to append 59 modifier to SLN Bx.

Example of when NOT to bill SLN Bx w/ Mastectomy: The planned procedure was mastectomy w/axillary lymphadenectomy, SLN bx results are malignant. (Results did not change planned procedure).
Hopes this helps?

 

[Trendale]

Masectomy Reply

Thank you Evangelina. The information you gave has been really helpful. Thanks!

 

[cmartin]

It is coded separately when the mastectomy is partial or simple, and ONLY the sentinel node(s) removed.
C.Martin, CPC-GENSG