General Surgery Coding Alert

Question: If the surgeon performs a partial mastectomy and an open axillary sentinel lymph node  excision of three nodes, should I code this as 19302 or 19301 plus 38525?

New York Subscriber

Answer: You should code the partial mastectomy as 19301 (Mastectomy, partial [e.g., lumpectomy, tylectomy, quadrantectomy, segmentectomy). You should separately code the sentinel lymph node biopsy using the appropriate code based on the depth of the nodes, such as 38500 (Biopsy or excision of lymph node[s]; open, superficial).

Here's why: You should not list 19302 (... with axillary lymphadenectomy) for the service because a lymphadenectomy describes a regional lymph node resection, not excision of one or a few specific sentinel nodes.

Caveat: If the surgeon removes a sentinel node, then it returns positive for metastasis and the surgeon goes on to perform a lymphadenectomy in the same operative session, you should not separately bill the sentinel node biopsy. In that case you should choose the appropriate code for mastectomy with lymphadenectomy, such as 19302.

Watch depth: You can't assume a depth for the axillary lymph nodes. That's why the correct code for the sentinel nodes may or may not be the code you suggest -- 38525 (... open, deep  xillary node[s]).

The surgeon should note depth in the operative note.

Capture sentinel dye: If the surgeon injects a dye to assist in visualizing the lymph field drainage pattern to identify the sentinel node(s), you should also report 38792 (Injection procedure; for identification of sentinel node).