Mastectomy coding


Glesns Falls, NY
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I recently struggle with mastectomies procedures :
The patient presents with a diagnosis of invasive ductal carcinoma of left breast. Clinical Stage I. After a complete review of treatment options, the patient has elected to proceed with breast conserving surgery.

...The left breast and axilla were prepped and draped in the usual sterile fashion.
Using gamma probe the radioactive tracer was mapped to the axilla. An incision was made at the level of the inferior left axillary hair line.
Dissection was carried down, through the clavipectoral fascia, into axilla. Guided by the gamma probe, the axilla was explored. The lymph node with radioactive counts was grasped with babcock clamp and dissected free from surrounding structures. Lymphatics and vessels were clipped. When the node was removed, exploration revealed another node with radioactive counts. This node was also grasped with Babcock clamp and dissected free from surrounding structures. Lymphatics and vessels were clipped. When both nodes had been removed there were no additional nodes remaining that were enlarged, suspicious, or containing radioactive counts above background. The sentinel nodes were sent to pathology.
Attention was turned to the breast. An elliptical incision was made in the upper ouer aspect of the left breast which incorporated the skin directly over the superficial tumor. dissection was carried out raising skin flaps and then the tumor was grasped with an Allis clamp and sharply excised. The specimen was oriented for pathology with margin mark ink.
....The breast and axillary incisions were then closed in layers...

Patient had prior sentinel node injection by radiologist 38792

my question is : do I code all the procedure this way :
38792 by radiologist
19301;38525; 38900 for surgeon ?

the most confusing is these two codes for mapping and injection : 38792&38900



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Teresa, based on the report, there was no blue dye injected by the surgeon, only the radioactive tracer injected by radiology. The surgeon did use the Gamma probe to map the radioactive tracer.

I believe the question is, can 38900 be used when the surgeon only uses a gamma probe for mapping, or must she also inject non-radioactive dye in order to use this code?

(I've never found a clear answer to that question--everyone always assumes the surgeon also injected dye.)


True Blue
Daytona Beach, FL
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38900 is the add on code used for the nonradioactive dye injected into the area used during a sentinel node procedure. If this is not done, then I would not use this code. The radioactive tracer injected by the radiologist is different.

Intraoperative mapping may be utilized during lymph node biopsy procedures. During the procedure, a nonradioactive dye such as methylene blue is injected into the area of focus. Following the path of the dye with the aid of fluorescence imaging, the first lymph node to receive lymphatic drainage from a tumor (sentinel lymph node) is identified and a separately reportable biopsy follows.