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Pathology/Lab Coding Alert

Get Paid for Sentinel Lymph Node Biopsy

- Published on Mon, May 01, 2000
CPT 2000 does not contain a specific procedural code for sentinel lymph node biopsy. That may mean some practices are not capturing the full reimbursement they are entitled to for the steps involved in the procedure.

Sentinel lymph node biopsy is a fairly new procedure used to detect the spread of breast cancer or melanoma (skin cancer) to the lymph nodes, says Matthew McCoy, MD, pathologist at Methodist Hospital, a part of HealthSystem Minnesota in St. Louis Park, Minn. Because its new, we have to use existing procedural codes to describe the separate steps of the procedure and simply add them up.

The sentinel node is the first draining node of a regional lymph node basin. The theory behind sentinel lymph node biopsy is that the sentinel node is the first place cancer cells would lodge if they were traveling through the lymphatic system. Therefore, if the sentinel node contains no metastases, then neither will the remaining nodes in that basin. This procedure can give direction regarding the advisability of treatment options, such as complete node dissection, radiation therapy, and chemotherapy, states McCoy.

Sentinel node biopsy can entail more careful study for occult metastases because it involves one or a few nodes, as opposed to 20 or 30 from a regional resection, continues McCoy. The nodes can be examined using serial sectioning or histochemical staining techniques to identify micrometastases, which have been associated with recurrence of the disease. This type of in-depth histologic examination is not feasible for all nodes involved in a regional resection.

Breast Cancer: A Clinical Example

A patient presenting with a suspected neoplasm of the breast, ICD9 239.3 (breast neoplasm of unspecified nature), first would undergo a diagnostic test to determine the nature of the lump. This might be done using fine needle aspiration (FNA), which is coded 88170 for superficial lesions, or 88171 for deep tissue lesions aspirated under radiologic guidance. The pathologist reports codes 88172 (evaluation of fine needle aspirate with or without preparation of smears; immediate cytohistologic study to determine adequacy of specimen[s]) and 88173 ( interpretation and report) if these services are provided.

More often, we use a radiologically guided Tru-Cut core biopsy for diagnostic purposes, reports McCoy. The surgical procedure is reported using code 19100 (biopsy of breast; needle core) and the radiological supervision with code 76095 (stereotactic localization for breast biopsy). The pathologists gross and microscopic evaluation of the core-needle biopsy is coded 88305 (breast, biopsy, not requiring microscopic evaluation of surgical margins). If the biopsy reveals a malignant neoplasm of the breast [174.x], the patient is scheduled for surgery at a later date.

The sentinel lymph node biopsy is conducted at the time of surgery. According [...]

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