General Surgery Coding Alert

Question: When the physician performs four injections in the left breast for one sentinel node and four injections in the right breast for one sentinel node, how should I code?


Maryland Subscriber


Answer: Physicians often perform more than one injection to identify the sentinel node from a single breast cancer or biopsy site. If the patient has tumors in both breasts, you should report 38792 (Injection procedure; for identification of sentinel node) once for each breast. Code 38792 is eligible for bilateral payment, so you can report the code once with modifier 50 (Bilateral procedure), or you can report it once with modifier LT (Left side) and once with modifier RT (Right side). Often, this depends on the payer. For a Medicare patient, you can expect to receive 100 percent of the allowable for the first procedure and 50 percent for the second procedure. Remember that if you are performing lympho-scintigraphy (lymph node imaging), you should report 78195 (Lymphatics and lymph nodes imaging), not 38792. Report 38792 only if no imaging service is performed.