Go Back   AAPC Medical Coding & Billing Forums > Medical Coding > General Surgery
Forum Rules FAQ Members List Calendar Search Today's Posts Mark Forums Read

Reply
 
Thread Tools
  #1  
Old 10-31-2008, 12:18 PM
LLovett LLovett is offline
True Blue
 
Join Date: Apr 2007
Posts: 1,638
LLovett is on a distinguished road
Default Lymph node removal or is it?

I am running into an unusual situation with one of our breast surgeons and I would like some opinions on what others would do with this.

"The breast was prepped and draped in the usual sterile fashion. An incision was made in the axillary fold and dissected down through the axilary fascia. The gamma probe was used to guide the resection and three sentinel lymph nodes were identified. They were all hot and none of them were blue. The count measured 4436 for the first node, 4519 for the second node and 634 for a third node. The axillary basin count was 35 and they were all negative on intraoperative pathologic evaluation. The axillary cavity was irrigated and then closed in standard fashion."

Would you bill the 19301 or 19302? The rest of the note is complete and there are no questions, it is just the lymph node portion that is causing us to take pause. I am not giving credit for the lymph nodes and coding 19301 based on this documentation.

Thanks

Laura, CPC
Reply With Quote
  #2  
Old 10-31-2008, 12:54 PM
mmelcam's Avatar
mmelcam mmelcam is offline
Expert
 
Join Date: Apr 2007
Location: St. Louis, Missouri
Posts: 259
mmelcam is on a distinguished road
Default

Did the path report show lymph nodes? If it did, you might want to take the op report back to your physician and have him document that they were removed.
__________________

Melissa Blow, CPC
Reply With Quote
  #3  
Old 10-31-2008, 01:03 PM
LLovett LLovett is offline
True Blue
 
Join Date: Apr 2007
Posts: 1,638
LLovett is on a distinguished road
Default

That is a good option on more current visits, I am looking at older charges (Dec 07) that were somehow missed and just now turned up on a missing list. What I am taking from your comment, though, is that you would not give credit based on the note I have in front of me.

Thanks

Laura, CPC
Reply With Quote
  #4  
Old 10-31-2008, 01:20 PM
magnolia1 magnolia1 is offline
Expert
 
Join Date: Apr 2007
Location: Albany, New York
Posts: 456
magnolia1 is on a distinguished road
Smile

To respond to your question regarding use of 19301 or 19302, I don't see any mention of a breast mass/ lump being removed in your report.
However, if a breast mass/ lump was removed, you can only use 19301 if the surgeon takes additional margins during that same surgery.
You cannot use 19302 unless a total axillary dissection is done in addition to lump (and margin) removal.
If surgeon is solely doing axillary sentinal biopsy, your choice would be 38525.

Hope this helps.....
__________________
Karen Maloney, CPC
Data Quality Specialist
Reply With Quote
  #5  
Old 10-31-2008, 01:30 PM
LLovett LLovett is offline
True Blue
 
Join Date: Apr 2007
Posts: 1,638
LLovett is on a distinguished road
Default

I only posted the portion of the note in question, the rest of it completely supports the partial mactectomy. Thanks so much for the input!

Laura, CPC
Reply With Quote
  #6  
Old 11-17-2008, 10:59 AM
cmartin cmartin is offline
Guru
 
Join Date: Apr 2007
Posts: 204
cmartin is on a distinguished road
Default

You bill the 19301 and the 38525 when sentinel nodes are removed in these circumstances - 19302 is meant to be used when the axillary contents, rather than just the sentinel node(s) are removed, and has a greater valuation than the combination of the other two codes.
C.Martin CPC-GENSG
Reply With Quote
  #7  
Old 11-17-2008, 12:02 PM
LLovett LLovett is offline
True Blue
 
Join Date: Apr 2007
Posts: 1,638
LLovett is on a distinguished road
Default

So you give credit for removal when they don't actually say they removed anything?

Thanks

Laura, CPC
Reply With Quote
  #8  
Old 11-17-2008, 12:10 PM
cmartin cmartin is offline
Guru
 
Join Date: Apr 2007
Posts: 204
cmartin is on a distinguished road
Default

I'm pretty sure they had to be removed before they could either take the count for radioactivity or do the intraoperative pathological evaluation - aka frozen section - on them.
Reply With Quote
Reply

Thread Tools

Posting Rules
You may not post new threads
You may not post replies
You may not post attachments
You may not edit your posts

BB code is On
Smilies are On
[IMG] code is On
HTML code is Off




Disclaimer: Although AAPC staff members will monitor these forums periodically, we cannot be responsible for the information posted herein, nor guarantee its accuracy. Our members may discuss various subjects related to medical coding, but none of the information should replace the independent judgment of a physician for any given health issue. Please note that the opinions expressed here do not necessarily reflect those of AAPC.

All times are GMT -6. The time now is 10:44 PM.

AAPC - Top

Powered by vBulletin® Version 3.8.1
Copyright ©2000 - 2014, Jelsoft Enterprises Ltd.
Copyright ©2014, AAPC