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are 38792 and 38900 actually bundled?

  1. Default are 38792 and 38900 actually bundled?
    Medical Coding Books
    I've been coding as if they are, but I can't find anything actually stating that they are. 38900 stipulates that "injection of non-radioactive dye, when performed" is included, but the AMA's notes state that injection of radioactive tracer should be coded with CPT 38792.

    So, if you're doing a sentinel lymph node mapping procedure with injection of a radioactive tracer, why wouldn't we use both codes?

    The Medicare reimbursement (in my area) for CPT code 38792 is only $41.68, while the reimbursement for 38900 is $147.88. It just doesn't make sense to me to use 38792 by itself, but 38900 specifically excludes the radioactive dye.

    Does anyone have documentation stating you can't use both, or has anyone received denials from payers for coding both codes?

  2. #2
    Default are 38792 and 38900 actually bundled?
    38900 should be reported by the surgeon performing the sentinel node biopsy when the mapping is performed during the operative session. It is used to report nonradioactive dye being injected into the area of focus.

    38792 is typically performed by an interventional radiologist prior to surgery and is used to report radioactive tracer.

    It would not be appropriate to report both codes for identification of the same sentinel node.
    Mickie Kummer, CPC, CPMA, CRC, CPC-I, AAPC Fellow

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