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Is the dye billable? 38900?

  1. #1
    Jamaica, NY
    Post Is the dye billable? 38900?
    Medical Coding Books
    Doctor wants to bill 49010, 10140, and 38900, but the 38900 is for lymp nodes. Can the dye be billed with another code?

    The patient is an 89-year-old male who was referred to me for evaluation of a
    left groin lymphocele. The patient had undergone a percutaneous placement of
    a coronary valve approximately 9 months previously. The patient subsequently
    developed a slowly enlarging mass of the left groin which was determined by
    noninvasive testing to be consistent with a lymphocele. I discussed with the
    patient and his daughter the possibilities for treatment and reconstruction.
    I discussed with them the possibility of exploring the groin and possible
    need for treatment with flap reconstruction. I also discussed intraoperative
    lymphatic mapping in order to try and isolate the leaking lymphatic channels.
    All risks, benefits, alternatives and complications were discussed in detail
    with the patient who understood these and agreed to surgery and an operative
    date was scheduled.
    On the date of operation the patient was brought to the operating room and
    placed on operating table in the supine position. Noninvasive hemodynamic
    monitoring devices were placed on the patient by the Anesthesia team,
    intravenous access obtained by the Anesthesia team and a perioperative dose
    of antibiotics was given. After induction of general anesthesia and securing
    of the airway, the patient was prepped and draped in the usual sterile
    The operation commenced by entering the left groin through his previous
    cutdown site. The lymphocele cavity was entered and several hundred cc of
    clear straw-colored fluid was encountered. The lymphocele cavity which had an
    anterior component and also then seemed to track deeper posteriorly. 1 cc of
    blue dye was injected at the level of the ankle circumferentially in an
    effort to map at the lymphatics involved in the leak. After allowing for
    10-15 minutes for the lymphazurin blue to travel up the leg, no leaking
    lymphatics were identified. The decision was made at this point to further
    explore posteriorly in the cavity into the retroperitoneum. A small incision
    was made and the dissection into the retroperitoneum was begun. However,
    because of the very significant adherence of the posterior wall of the
    lymphocele cavity to the vessels in the area, the decision was made to abort
    further exploration with plans to return to explore the area in concert with
    the vascular surgery service.
    At this point the lymphocele cavity was oversewn with several 0 Maxon
    sutures. A #10 flat Jackson-Pratt drain was placed through a stab incision to
    lie within the obliterated cavity and was secured with a 3-0 nylon suture.
    The wound was once again thoroughly irrigated and hemostasis obtained. The
    superficial fascia closed with 2-0 Polysorb, the deep layer closed with 3-0
    Polysorb and the skin edges were stapled. A sterile dressing was applied. The
    patient was awoken, extubated and transferred to the recovery room in stable

  2. Default
    Use Q9968 for the isosulfan blue. Bill for each MG administered/used.

  3. #3
    CPT 38900 can only be billed with certain codes and includes the non-radioactive blue dye injection. When radioactive dye is injected I bill 38792 with modifier 59.
    The codes you listed do not allow sentinel lymph node mapping.

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