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Who gets to bill the 38792?

  1. #1
    Question Who gets to bill the 38792?
    Medical Coding Books
    I am having a minor crisis and really need some clarification. When my surgeons do an injection of the blue dye for a sentinel lymph node identification, we use code 38792. Apparently the radiologist, who is injecting a radioactive dye prior to the patient being take to the OR is also using code 38792. Medicare will not pay both doctors if they both use code 38792. Has anyone else had this problem? What is the correct code for the Radiology procedure? They are not doing any images so they won't use a Radiology code. One of the surgeons I work for says that this has happened in the past and that the Radiology group is using the incorrect code. I have spent WAY too much time on this for what we actually get reimbursed but feel it is important that we (both the Radiologists and myself) know the correct way to code these procedures. Pelase help!
    Chrissy, CPC

  2. Default
    I ran down this item I posted months ago on a related subject - maybe the article referred to can help?
    Our Medicare B Carrier, National Govt Services, just released sentinel lymph node policy, Article A47181, which states that 38792 is appropo for the surgeon injecting dye AND/OR other substances for ID of sentinel node.
    "CPT code 38792 can be billed for both the injection of radioactive tracer when performed without lymphoscintigraphy; and for the injection of vital dye (Isosulfan Blue Dye or a similar product) to visualize the sentinel node, by the surgeon/physician who performs the injection." [I cut and pasted that line from the article on the NGS website]
    Connie Martin

  3. #3
    Maybe you just need to decide who adds the 59 modifier as a routine...

  4. #4
    Albany, New York
    If the injection is being done in Radiology (by a Radiologist) prior to patient going to the OR, then the Radiologist (not the surgeon ) would code for this.
    Karen Maloney, CPC
    Data Quality Specialist

  5. #5
    Default 38792
    Based on the article posted previously, both the Radiologist and the Surgeon can bill this code because the actual interpretation of the procedure is different for each provider.

  6. Default
    Could you use a 77 modifier.

  7. #7
    Albany, New York
    The previous article states that the provider (surgeon/ or other physician) who gives the injection is the one who codes/ bills for it.
    Karen Maloney, CPC
    Data Quality Specialist

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