Wiki Lymph node removal or is it?


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I am running into an unusual situation with one of our breast surgeons and I would like some opinions on what others would do with this.

"The breast was prepped and draped in the usual sterile fashion. An incision was made in the axillary fold and dissected down through the axilary fascia. The gamma probe was used to guide the resection and three sentinel lymph nodes were identified. They were all hot and none of them were blue. The count measured 4436 for the first node, 4519 for the second node and 634 for a third node. The axillary basin count was 35 and they were all negative on intraoperative pathologic evaluation. The axillary cavity was irrigated and then closed in standard fashion."

Would you bill the 19301 or 19302? The rest of the note is complete and there are no questions, it is just the lymph node portion that is causing us to take pause. I am not giving credit for the lymph nodes and coding 19301 based on this documentation.


Laura, CPC
Did the path report show lymph nodes? If it did, you might want to take the op report back to your physician and have him document that they were removed.
That is a good option on more current visits, I am looking at older charges (Dec 07) that were somehow missed and just now turned up on a missing list. What I am taking from your comment, though, is that you would not give credit based on the note I have in front of me.


Laura, CPC
To respond to your question regarding use of 19301 or 19302, I don't see any mention of a breast mass/ lump being removed in your report.
However, if a breast mass/ lump was removed, you can only use 19301 if the surgeon takes additional margins during that same surgery.
You cannot use 19302 unless a total axillary dissection is done in addition to lump (and margin) removal.
If surgeon is solely doing axillary sentinal biopsy, your choice would be 38525.

Hope this helps.....
I only posted the portion of the note in question, the rest of it completely supports the partial mactectomy. Thanks so much for the input!

Laura, CPC
You bill the 19301 and the 38525 when sentinel nodes are removed in these circumstances - 19302 is meant to be used when the axillary contents, rather than just the sentinel node(s) are removed, and has a greater valuation than the combination of the other two codes.
So you give credit for removal when they don't actually say they removed anything?


Laura, CPC
I'm pretty sure they had to be removed before they could either take the count for radioactivity or do the intraoperative pathological evaluation - aka frozen section - on them.