38570 or 38571 Pelvic Sentinel lymph nodes.

natashalage

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Hello Coding Community! :) I need your help and I will greatly appreciate your assistance in the case below. Thank you!
My question is do we bill 38570 for sentinel nodes or 38571-for pelvic lymphadectomy? My rational is to bill for only Sentinel nodes since no bilateral Pelvic lymphadectomy was done. It was just sampling to see if the cancer spread.
38570- Laparoscopy, surgical; with retroperitoneal lymph node sampling (biopsy), single or multiple
38571- Laparoscopy, surgical; with bilateral total pelvic lymphadenectomy
Pt has endometrial adenocarcinoma.
OPERATION:
1. Diagnostic laparoscopy
2. Bilateral sentinel lymph node dissection
3. Peritoneal washings.
Extracts from Op note: "....I discussed with Dr. N. the paradigm for sentinel lymph node evaluation in atypical hyperplasia and in low grade endometrioid adenocarcinoma.
Findings: ...5. Successful bilateral sentinel lymph node mapping to the mid-portion of the external iliac vessels. Two nodes mapped in the left hemipelvis and one node mapped in the right. There were no ICG avid para-aortic lymph nodes seen.
DESCRIPTION OF PROCEDURE:
The retroperitoneum was opened bilaterally to identify the bilateral pelvic sentinel lymph nodes. The peritoneum overlying the external iliac artery was incised with Ligasure. The ureter was identified in the retroperitoneal space and mobilized medially away from the pelvic vessels to develop the para-rectal space. The superior vesicle artery was the mobilized medially to open the obturator space. I used the fluorescent filter on the laparoscopic camera to identify the sentinel lymph node(s) which were located as described above. These nodes were elevated away from the vascular structures and the areolar tissue was dissected to isolate the sentinel lymph node from the underlying vascular structures. Care was taken to identify the ureter to avoid injury to this structure. On the right hand side the sentinel lymph node was located as described above. This node was similarly elevated from the underlying vascular structures and dissected away from the vessels with care to identify and reflect the ureter away from the sentinel lymph node. The sentinel lymph node on both sides were then sent to pathology for review.

After completion of the sentinel lymph node dissection, the case was handed over to Dr. N's team for completion of the hysterectomy. "
PATHOLOGY REPORT: A. Bilateral pelvic sentinel lymph nodes #1, dissection
Pelvic lymph nodes: Uninvolved by carcinoma.
-Total number (including sentinel nodes) examined: 5.
-Number of sentinel nodes examined: 5.
Para-aortic lymph nodes: None submitted.
THANK YOU VERY MUCH.
 

csperoni

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For SENTINEL lymph nodes, 38570 is the correct code. Sometimes the nodes don't map and physician winds up doing a full 38572 but that is rather rare.
From SGO: https://www.sgo.org/resources/coding-qa-endometrial-cancer/
Specifically:
"Sentinel node mapping would use 38900 -50 for bilateral injection of dye and 38570 for node biopsy. If full node dissection needs to be done because of non-mapping or some other reason you can still bill the 38900-50 if the injection was done."
I will note here that TECHNICALLY SGO's advice for using 38900-50 is incorrect since 01/01/2020 as 38900 is an add on code. The guidelines changed for add on codes to not use -50 but rather -LT and -RT. From my experience, carriers never updated this guideline for add on codes, and will still pay as 38900-50.
 

natashalage

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Thank you very much, Christine, for your response. Many of us are continuing learning a lot from your posts in OBGYN forum. We greatly appreciate you sharing your knowledge and experience with us. I hope one day I will become helpful to others like you. Thank you a lot! :)
 
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