Question Sentinel lymph nodes in breast cancer cases

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Oviedo, FL
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I am confused about coding for sentinel lymph nodes in breast cancer cases. If the container is labeled "sentinel lymph node" and two or more lymph nodes are found, processed, and read by the pathologist, would that result in an 88307 x # of sentinel lymph nodes or only 88307 x 1? Thanks for any clarification.
 

danachock

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Brainerd, MN
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Hi psnoopy1962@gmail.com

I will try to assist. It really depends on the pathology report (documentation is so important). It almost sounds like additional Sentinel lymph nodes were possibly acquired unintentionally (like incidental) in a sense.
Let me provide a few fictious examples (absolutely no PHI) off the top of my head and see if they may possibly fit your coding scenario okay.

First Example:
Pathology department receives A) Right Breast Core Biopsies and B) Sentinel Lymph Node
Gross Description states something like this - Specimen A) Received three cores measured in aggregate measured xxxxx and placed in cassettes labeled A1-A4. Specimen B) Received sentinel lymph node and identified two lymph nodes. Placed first larger lymph node in cassettes labeled B1-B2 and the smaller lymph node into cassettes labeled B3-B4.
Pathologist's renders final diagnosis: Specimen A) Breast Cancer and Specimen B) The larger lymph node was positive for metastatic cancer and the smaller was negative (no abnormal findings)
I'd be all right billing 88305 for breast cores and 88307x2 for the sentinel lymph nodes (separately identifiable). They stated the larger one versus smaller one and final diagnosis distinguishes the difference in the relationship.
Note: It is very rarely I see this type of documentation in the pathology report “in my opinion” that I feel can support this type of billing scenario especially if faced with a denial and you need to send the “notes” to support billing those charges, so please be very cognizant reviewing your pathology report.

I am not billing anything that is not simply supported by the pathology report. So if they gave us undesirable documentation, that is how I will bill it such as the second example I am providing. So many more providers could capture so much more RVU's if they slowed down and documented what we needed.

Second Example:
Pathology department receives A) Right Breast Core Biopsies and B) Sentinel Lymph Node
Gross Description states something like this - Specimen A) Received three cores measured in aggregate measured xxxxx and placed in cassettes labeled A1-A4. Specimen B) Received sentinel lymph node and identified two lymph nodes. Placed both lymph node in cassettes labeled B1-B4.
Pathologist's renders final diagnosis: Specimen A) Breast Cancer and Specimen B) 2 Sentinel lymph nodes reviewed (1of 2 received) are positive for metastatic cancer.
I'd bill 88305 for breast cores and 88307x1 for the sentinel lymph nodes in this scenario.

Other factors to look at when you receive a Sentinel lymph node excision and surgeon realizes that more than one lymph node has been acquired; they may simply add a stitch or ink to identify one lymph node separately from the other before shipping sending it to the pathology department. Be sure to be looking for that information most likely in the “Gross Description” of your report please.

Thank you for listening and have a wonderful evening,
Dana Chock, CPC, CANPC, CHONC, CPMA, CPB, RHIT
 
Messages
2
Location
Oviedo, FL
Best answers
0
Hi psnoopy1962@gmail.com

I will try to assist. It really depends on the pathology report (documentation is so important). It almost sounds like additional Sentinel lymph nodes were possibly acquired unintentionally (like incidental) in a sense.
Let me provide a few fictious examples (absolutely no PHI) off the top of my head and see if they may possibly fit your coding scenario okay.

First Example:
Pathology department receives A) Right Breast Core Biopsies and B) Sentinel Lymph Node
Gross Description states something like this - Specimen A) Received three cores measured in aggregate measured xxxxx and placed in cassettes labeled A1-A4. Specimen B) Received sentinel lymph node and identified two lymph nodes. Placed first larger lymph node in cassettes labeled B1-B2 and the smaller lymph node into cassettes labeled B3-B4.
Pathologist's renders final diagnosis: Specimen A) Breast Cancer and Specimen B) The larger lymph node was positive for metastatic cancer and the smaller was negative (no abnormal findings)
I'd be all right billing 88305 for breast cores and 88307x2 for the sentinel lymph nodes (separately identifiable). They stated the larger one versus smaller one and final diagnosis distinguishes the difference in the relationship.
Note: It is very rarely I see this type of documentation in the pathology report “in my opinion” that I feel can support this type of billing scenario especially if faced with a denial and you need to send the “notes” to support billing those charges, so please be very cognizant reviewing your pathology report.

I am not billing anything that is not simply supported by the pathology report. So if they gave us undesirable documentation, that is how I will bill it such as the second example I am providing. So many more providers could capture so much more RVU's if they slowed down and documented what we needed.

Second Example:
Pathology department receives A) Right Breast Core Biopsies and B) Sentinel Lymph Node
Gross Description states something like this - Specimen A) Received three cores measured in aggregate measured xxxxx and placed in cassettes labeled A1-A4. Specimen B) Received sentinel lymph node and identified two lymph nodes. Placed both lymph node in cassettes labeled B1-B4.
Pathologist's renders final diagnosis: Specimen A) Breast Cancer and Specimen B) 2 Sentinel lymph nodes reviewed (1of 2 received) are positive for metastatic cancer.
I'd bill 88305 for breast cores and 88307x1 for the sentinel lymph nodes in this scenario.

Other factors to look at when you receive a Sentinel lymph node excision and surgeon realizes that more than one lymph node has been acquired; they may simply add a stitch or ink to identify one lymph node separately from the other before shipping sending it to the pathology department. Be sure to be looking for that information most likely in the “Gross Description” of your report please.

Thank you for listening and have a wonderful evening,
Dana Chock, CPC, CANPC, CHONC, CPMA, CPB, RHIT
Thank you so much for your insight. The scenarios make perfect sense as to the codes that can be applied.
 
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