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1. When a sentinel node biopsy (CPT 38500) is performed during the same operative session as, for example, axillary node dissection (CPT 38740-38745), the sentinel node biopsy is not billed separately.
2. However, if sentinel nodes are biopsied during the same operative session through a different incision, it is appropriate to bill both using the proper code, appending a -59 modifier to the second CPT code.
3. CPT code 38792 can be coded for the injection procedure to identify a sentinel node, and CPT code 78195-TC for related imaging. (When billable, check for bundling issues.)
4. If the operative report states that the injection procedure was done prior (the day before surgery) and not done at the ASC, CPT code 38792 should not be coded.
Learn more about Serbin Surgery Center Billing.
The information provided should be utilized for educational purposes only. Please consult with your billing and coding expert. Facilities are ultimately responsible for verifying the reporting policies of individual commercial and MAC/FI carriers prior to claim submissions.
Read more practical guidance from Caryl Serbin:
- 8 Quick Tips for Picking the Best Insurance Plans for Your ASC
- 12 Best Practices for Analyzing Business Terminology in Payor Contracts
- What to Audit When You Audit Your ASC's Billing Process