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Lymphoscintigraphy

  1. #1
    Location
    Pottstown/Philadelphia
    Posts
    266
    Default Lymphoscintigraphy
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    How would you code for this? An injection into the breast for lymph node mapping. Thanks.

  2. Default
    When lymphoscintigraphy is performed in advance of the
    surgical procedure to mark and locate the sentinel node(s), the
    injection should be reported using CPT code 38792 and CPT
    code 78195 should be used to report the lymphoscintigraphy.
    Kelly Long CPC, CFE
    Manager Audit and Compliance

  3. #3
    Location
    Pottstown/Philadelphia
    Posts
    266
    Default
    thanks, kel

  4. #4
    Default
    I think they're bundled. 38792 is included in 78195. Not sure you can over ride that one. I could be wrong though. I bill for them once in awhile. Mine are usually just sentinel node injections. I also read a coding alert that said you can bill the injection twice if they're injecting more than 1 node. My docs make several injections but they're all for the same node so it's important to watch they're documentation.

  5. Default Sentinel node
    Sharing my thoughts in this senario:
    78195 - Sulfide colloid is injected according to the lymph node to be visualized
    Then imaging done.(Only colloid is injected and imaging done then code 78195)

    But in

    38792 - The physician injects dye or contrast material into the patient to identify the sentinel lymph node As soon as the node is visualized, the radiologist makes a small longitudinal incision over the area. The node is exposed and cannulated with a 27- or 30-gauge needle attached to a fine catheter(These procedure should mentioned)
    Shirley CPC,CPC-H

  6. #6
    Default
    I have coded both the 78195 and 38792 and insurance co's deny them stating 78195 is mutually exclusive to 38792. I have added a modifier onto the 78195 and havent received anything back from the insurance co yet. If anyone can shed some light on this topic for me I'd appreciate it.

  7. #7
    Location
    Pottstown/Philadelphia
    Posts
    266
    Default
    keyne, which modifier did you use and who was the insurance co? So are we supposed to code only the 7000? or can we do both codes? Anyone who knows would be great.

  8. #8
    Default
    Quote Originally Posted by jifnif View Post
    keyne, which modifier did you use and who was the insurance co? So are we supposed to code only the 7000? or can we do both codes? Anyone who knows would be great.
    I used the modifier 59 and it was Aetna. They paid the 38792 but didn't pay the 78195 with the modifier. The physicians are performing both procedures, and I want clarification before I tell them they can't bill for both.

  9. #9
    Location
    New Haven, CT
    Posts
    32
    Default Lymphoscintigraphy
    You can only code 78195 OR 38792 - cannot code them together - Code 78195 includes the injection of the radioactive tracer. The separate injection code (38792) can only be used if the injection is performed and NO imaging occurs.
    Shar

  10. #10
    Default
    Thank you.

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