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deep seninel node dissection fo rvulva cancer

Becky Posted Thu 09th of February, 2017 08:06:59 AM
How would you code this? inguinal lymph nodes. Right deep sentinel lymph node #1 that was blue and not hot, right superficial sentinel lymph node #2 that was blue and hot at 100 counts at 1000X, superficial sentinel lymph node #3 that was not blue and hot to 100 counts at 100X, right deep sentinel lymph node #4 that was hot to 8000 counts at 1000X but not blue. Left chest skin tag.  
SuperCoder Answered Fri 10th of February, 2017 01:45:45 AM

As per the limited information provided supercoder can suggest coding as per below guidelines:

  • If your surgeon documents injecting dye to identify the first-draining node(s) in the lymph node basin, then removing a sentinel lymph node based on the findings, you can report that work in addition to a mastectomy. The base code for the sentinel lymph node biopsy is one of the following, depending on the approach and the node(s) location: 38500 -- Biopsy or excision of lymph node(s); open, superficial 38505 -- … by needle, superficial (e.g., cervical, inguinal, axillary) 38525 -- … open, deep axillary node(s) 38530 --… open, internal mammary node(s). You can list +38900 (Intraoperative identification [e.g., mapping] of sentinel lymph node(s) includes injection of non-radioactive dye, when performed [List separately in addition to code for primary procedure]) with any of the lymph node biopsy codes as a base code when your surgeon documents the work. 
  • Injection of vital dye (Isosulfan Blue Dye or similar agents) to visualize the sentinel node may not be reported separately.

    The radiopharmaceutical is payable only when billed with the imaging code (CPT code 78195).

Also, AAE does not provide coding for operative reports and chart notes.

 SuperCoder offers SuperCoder on Demand (SOD) ( for coding of an operative report or chart note and you can contact (866)228-9252 or e-mail for more information.


Becky Posted Sat 11th of February, 2017 09:15:19 AM
My doctor is stating they are deep inguinallymph nodes so is 38500 the only code I can use ?
SuperCoder Answered Mon 13th of February, 2017 23:47:53 PM

As Per the CPT assistant it is coded with 38500

Jan 2009 CPT Assistant: Question: What is the most appropriate code to report a simple, deep lymph node excision of the inguinal area (not a radical lymphadenectomy)? 

Answer: From a CPT coding perspective, code 38760, Inguinofemoral lymphadenectomy, superficial, including Cloquets node (separate procedure), represents a procedure for a superficial dissection of the inguinal lymph nodes (groin nodes) and is commonly performed for malignancy. Code 38765, Inguinofemoral lymphadenectomy, superficial, in continuity with pelvic lymphadenectomy, including external iliac, hypogastric, and obturator nodes (separate procedure), represents the work described by code 38760 plus a deep dissection of the pelvic lymph nodes on the same side as the superficial dissection. If a full dissection is not performed (regardless of depth or regions), depending on the technique used, either code 38500, Biopsy or excision of lymph node(s); open, superficial, or code 38505, Biopsy or excision of lymph node(s); by needle, superficial (eg, cervical, inguinal, axillary), is reportable.

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