09/30/2019 – Axillary Sentinel Node Biops

Question: Surgeon performs an axillary sentinel node biopsy in conjunction with a partial mastectomy. Which anesthesia code(s) should be billed?

Answer:

The choice is easy because both surgical codes 38500 (Biopsy or excision of lymph node(s); open, superficial) and 38525 (Biopsy or excision of lymph node(s); open, deep axillary node(s)) cross to anesthesia code 01610 (Anesthesia for all procedures on nerves, muscles, tendons, fascia, and bursae of shoulder and axilla). Code 01610 has five base units.

Even if the surgeon reports a code such as 19302 (Mastectomy, partial (e.g., lumpectomy, tylectomy, quadrantectomy, segmentectomy); with axillary lymphadenectomy), we recommend still reporting 01610 instead of the primary anesthesia choice of 00400 (Anesthesia for procedures on the integumentary system on the extremities, anterior trunk and perineum; not otherwise specified) because the procedure involves axillary lymphatics.

Insider Tip: We use care around differentiating sentinel node biopsy vs. lymphadenectomy because confusing the two impacts claim accuracy.


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