Wiki Billing 38900 Intraoperative sentinel Node mapping for gyn onc

[garmab06]

Hi,
would you have information as to how to correct verbiage in box 19 for cpt code 38900/38589 when it's billing with a pelvic lymphadenectomy 38570, 38571 or 38572 done laparoscopic

Other payers try to include it with the lymphadenectomy procedure as inherit.


thank you for your help

 

[csperoni]

Late to answer, but I was updating a previous post from 2017 regarding this & saw your related question. In 2018, we used 38999 for the ICG sentinel lymph node mapping. I'm very pleased that as of 2019, 38900 has been updated and may be billed with 38570 - 38572.

The full list of base codes for 38900 as of 2019 is 19302, 19307, 38500, 38510, 38520, 38525, 38530, 38531, 38542, 38562, 38564, 38570, 38571, 38572, 38740, 38745, 38760, 38765, 38770, 38780, 56630, 56631, 56632, 56633, 56634, 56637, 56640.

 

[csperoni]

Of important note - forgot to mention earlier that 38900 can be billed with -50 if done bilaterally. I know my provider typically does an injection at 3 o'clock and 9 o'clock.

 

[stepht]

Is 38900 inherent to the gyn procedure if they do the injection but do not do a biopsy due to no abnormality of the lymph nodes?

 

[csperoni]

You can only bill 38900 with one of the base codes 19302, 19307, 38500, 38510, 38520, 38525, 38530, 38531, 38542, 38562, 38564, 38570, 38571, 38572, 38740, 38745, 38760, 38765, 38770, 38780, 56630, 56631, 56632, 56633, 56634, 56637, 56640. If you are not doing lymphadenectomy, you cannot bill 38900. Unlisted 38999 (what we had to use pre 2019), may be appropriate. Be prepared to submit op note and appeal letter.

Note - I'm certainly not a clinician, but my understanding of the ICG lymph node mapping simply indicates which are the sentinel lymph nodes, not whether there is any abnormality. I had 1 case over the years where they injected, but nothing came back on the mapping, so no lymphadenectomy was done. I decided it was not worth the hassle of billing 38999 and fighting for payment. I was literally 1 in maybe 200 cases. If it was something frequent (or even occasionally), I would fight for the payment.