![]() Responses to questions are intended only as a guide and are not a substitute for specific accounting or legal opinions. However, the information neither replaces information in Medicare regulations, the CPT-4 code book, or the ICD-9 CM code book nor does it constitute legal advice. Every effort is made to ensure the accuracy of the information provided. Vulvectomy, radical, partial with unilateral inguinofemoral lymphadenectomyĭisclaimer: SGO members and professional coders may seek coding advice and recommendations by submitting an email to Answers to incoming questions are provided by the members of the SGO Coding and Reimbursement Taskforce and represent their opinion based upon the current and usual practices in the field. Laparoscopy, surgical with bilateral total pelvic lymphadenectomyīiopsy or excision of lymph nodes, inguinofemoral node Intraoperative identification (e.g., mapping) of sentinel lymph nodes Laparoscopy, surgical with retroperitoneal lymph node sampling Holtz, MD, is a gynecologic oncologist with Lankenau Hospital in Wynnewood, PA. The permission from CMS to use the add on injection code for sentinel lymph node identification (+38900) along with the additional inguinofemoral lymph node dissection code (38531) will allow us to continue to be compensated for work as we transition toward sentinel lymph nodes in gynecologic malignancies.ĭavid O. This code cannot be billed with more extensive lymphadenectomy codes or any of the radical vulvectomy codes that already incorporate lymph node dissection (i.e. It can be billed at the time of a radical vulvectomy or as a subsequent separate procedure. The new code CPT 38531 is intended to be used with the 38900 add on code, can be billed for just unilateral lymph nodes or used twice for bilateral lymph nodes. CPT 38531 (biopsy or excision of lymph node(s) open, inguinofemoral node(s)) was created as an intermediate code between a simple open biopsy of the lymph node (CPT 38500) and more complex total lymph node dissections. The ability to bill for the injection of dye makes up for the difference in work and allows for the facility to bill for the dye.Ī new code has also been added that allows us to properly bill for the work performed during a groin dissection for sentinel lymph node biopsy. These codes all pay approximately 3.0 work relative value units (wRVUs) less than lymphadenectomy procedures (see table below). 1, 2019, gynecologic oncologists would have to use one of the open or laparoscopic lymph node sampling codes by themselves to bill for a sentinel lymph node dissection for endometrial or vulvar cancer. Given the acceptance of sentinel lymph node biopsy for vulvar cancer and endometrial cancer as seen in changes to the National Comprehensive Cancer Network (NCCN) guidelines over the past several years, this seemed like a good time to update the list of codes that CPT code +38900 could be billed with as supported by these NCCN guidelines. Previously, CPT code +38900 was restricted to procedures usually done for a diagnosis of breast cancer or melanoma and restricted from being billed with CPT codes for hysterectomies and vulvectomies. These changes are based on the work of the SGO Coding Taskforce and the American College of Obstetricians and Gynecologists (ACOG) Committee on Health Economics and Coding. These 2019 coding changes will affect how you bill for lymph node dissections. 1, 2019, there will be changes to the parenthetical statement under CPT code +38900 regarding the CPT codes that it can be billed with for intraoperative identification (e.g., mapping) of sentinel lymph nodes (SLN) for gynecologic malignancies and a new CPT code for biopsy of inguinofemoral nodes. Diversity, Inclusion, and Health Equity Blog.Diversity, Inclusion, and Health Equity.SGO BRIDGES Research Initiative – Meet the Scholars.SGO BRIDGES Research Initiative – Meet the Mentors.SGO Leadership, Engagement, and Action in Diversity (LEAD) Program – Meet the Mentors.SGO Leadership, Engagement, and Action in Diversity (LEAD) Program.Anti-Harassment and Anti-Discrimination Policy.Conflict of Interest Disclosure and Dissociation Policy. ![]()
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