Coding Sentinel Node Injection With and W/O Imaging

Question:
The radiology group that provides services for my hospital has been told that they cannot bill for (breast cancer) sentinel node injections unless imaging is performed after the injection. Can you tell me how they can bill just for injecting? Additionally, how should we code when we are performing the imaging?

Answer:

There is one code used to describe imaging Lymphoscintigraphy; CPT 78195, Lymphatics and lymph nodes imaging (For sentinel node identification without scintigraphy imaging, use 38792) (For sentinel node excision, see 38500-38542). For the injection procedure without imaging you may report CPT 38792 Injection procedure; radioactive tracer for identification of sentinel node (For excision of sentinel node, see 38500-38542) (For nuclear medicine lymphatics and lymph gland imaging use 78195 (For intraoperative identification (eg mapping) of sentinel lymph node(s) including injection of non-radioactive dye, see 38900).

Each CPT code is assigned in distinct and clearly defined circumstance, but the two CANNOT be used together by the same physician. The surgeon or other physician may also report the injection and mapping procedure CPT 38900 Intraoperative identification (eg, mapping) of sentinel lymph node(s) includes injection of non-radioactive dye, when performed, if he or she uses special dyes, i.e. blue dye, to help visualize the targeted or sentinel node.

In those cases where the nuclear medicine service is only an injection of the radioactive tracer following which the patient will be sent for a same day sentinel node biopsy, and the nodes will be located using an operative hand held gamma detector, imaging is not performed. When identification through injection of a radioactive tracer of a sentinel node(s) is performed without scintigraphy imaging, use CPT 38792.

The work and resources of an injection of the radioactive tracer is included in the lymphoscintigraphy imaging procedure CPT 78195, and is not reported separately. Therefore, it is inappropriate to report both CPT 38792 and CPT 78195 together.

The opinions referenced are those of the members of the SNMMI Coding and Reimbursement Committee and their consultants based on their coding experience. They are based on the commonly used codes in Nuclear Medicine, which are not all inclusive. Always check with your local insurance carriers as policies vary by region. The final decision for the coding of a procedure must be made by the physician considering regulations of insurance carriers and any local, state or federal laws that apply to the physicians practice. The SNMMI and its representatives disclaim any liability arising from the use of these opinions.