decemBER
2009
PARTIAL MASTECTOMY OR LUMPECTOMY WITH AXILLARY LYMPHADENECTOMY
Sometimes when performing a partial mastectomy
it’s necessary to remove axillary lymph nodes or biopsy the
sentinel node. A sentinel node is the first node in a lymphatic chain
to receive fluid from the primary tumor site which contains the metastisizing
cancer cells.
CPT code 19301 is reported for a partial mastectomy or lumpectomy
when the tumor is removed and specific attention is paid to the surgical
margins. The lymph node excision code is determined by the type of
procedure performed.
There are 3 levels of axillary lymph nodes Levels I-III. CPT code
38500 is reported for open excision or biopsy of superficial lymph
nodes - these nodes are usually palpable under the skin. Levels II
and III are deep and reported with CPT code 38525 (open, deep axillary
nodes). The depth of dissection should be documented in the op note
for coding accuracy.
Injection of dye to confirm a sentinel node is separately reported
with CPT code 38792 (injection procedure for identification of sentinel
node).
CPT code 19302 is only reported when “all identifiable axillary
lymph nodes are removed” – A separate incision may be
made but that is not what determines coding, reporting is based on
the extent of axillary lymph node dissection.
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