Radiology Coding Alert

Question: The physician performed a sentinel node injection with lymphoscintigraphy. A note with 38792 states to report 78195 for imaging. So why did Medicare deny a claim that included both codes? Texas Subscriber Answer: You should report 78195 (Lymphatic and lymph nodes imaging) for this service and leave 38792 (Injection procedure; for identification of sentinel node) off the claim. The Correct Coding Initiative (CCI) edits consider 38792 and 78195 to be mutually exclusive. Helpful: CPT Assistant (December 1999) explains that imaging code 78195 includes the injection: "The injection of radioactive tracer is included in the lymphoscintigraphy procedure performed at the same session and is not reported separately. Therefore, it is inappropriate to report 38792 when lymphoscintigraphy is performed." Clarify the note: CPT's note with 38792 does state, "For nuclear medicine lymphatics and lymph gland imaging, use 78195." You may want to add your own reminder that the instruction means to [...]