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Sentinel Node Injection Procedure

  1. #1
    Default Sentinel Node Injection Procedure
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    We are having issues when billing 78195 and 38792 on the same day. The patient is receiving a TC-99 injection from radiology and an Isosulfan Blue injection from the breast surgeon on the same day. We were advised to bill 38792 for the surgeon's injection of Isosulfan Blue dye for the identification of the sentinel node and 78195-52 to indicate nuclear medicine TC-99 injection without imaging, as no images are taken during these procedures. When we review the CCI edits for 78195 and 38792, the 52 modifier is not allowed. We feel this is incorrect advice and would like some guidance on how best to code this procedure. Thank you for your time.

  2. #2
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    Quote Originally Posted by tfrick2 View Post
    We are having issues when billing 78195 and 38792 on the same day. The patient is receiving a TC-99 injection from radiology and an Isosulfan Blue injection from the breast surgeon on the same day. We were advised to bill 38792 for the surgeon's injection of Isosulfan Blue dye for the identification of the sentinel node and 78195-52 to indicate nuclear medicine TC-99 injection without imaging, as no images are taken during these procedures. When we review the CCI edits for 78195 and 38792, the 52 modifier is not allowed. We feel this is incorrect advice and would like some guidance on how best to code this procedure. Thank you for your time.
    If the surgeon is injecting during the operative session, the surgeon should report 38900. 38792 is for radioactive material that is normally injected by the nuclear medicine. From the information provided I think you should be using 38792 for radiology since you are not doing imaging.
    Mickie Kummer, CPC, CPMA, CRC, CPC-I, AAPC Fellow

  3. #3
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    Oh my goodness, I never even saw that code! So do you know what the facility would bill, if anything?

  4. #4
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    Quote Originally Posted by tfrick2 View Post
    Oh my goodness, I never even saw that code! So do you know what the facility would bill, if anything?
    We do most of ours outpatient hospital in Same Day Surgery. They use the same codes.
    Mickie Kummer, CPC, CPMA, CRC, CPC-I, AAPC Fellow

  5. #5
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    Does the facility have any problems getting paid for these procedures? How about the radiologist & surgeon? Thanks so much for your input!

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