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Right Axillary Sentinel Node Biopsy-billing 38792 twice?

  1. #1
    Question Right Axillary Sentinel Node Biopsy-billing 38792 twice?
    Medical Coding Books
    I'm auditing the charges for a provider billing for both a right simple mastectomy as well as a right axillary sentinel node biospy.

    The physician administered both Filtered Technetium at the 6 o clock position of the right areola, as well as Methylene Blue in the subareolar area.

    The total bill came to us with the following codes:
    01 19303 MASTECTOMY, SIMPLE, COMPLETE
    02 38525 BIOPSY OR EXCISION OF LYMPH NODE(S); OP
    03 38792-51 INJECTION PROCEDURE; FOR IDENTIFICATION
    04 38792-51-RT INJECTION PROCEDURE; FOR IDENTIFICATION

    Is it appropriate for the provider to bill the 38792 twice, using these modifiers?

    Thanks!

    Jodie, CPC
    Last edited by dreampeddler; 04-28-2009 at 12:07 PM.

  2. Default
    Our Medicare carrier said that it was. I posted the info somewhere in these forums some time back; if I can find it, I'll repost it here.
    C.Martin
    ran down this item I posted months ago on a related subject - maybe the article referred to can help?
    C.Martin
    CPC-GENSG
    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
    Last edited by cmartin; 04-30-2009 at 01:36 PM.

  3. #3
    Default
    Thank you!

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