How To Use CPT Code 38792

CPT 38792 refers to the injection procedure of a radioactive tracer for the identification of sentinel nodes, commonly used in melanoma or breast cancer cases. This article will cover the description, procedure, qualifying circumstances, usage, documentation requirements, billing guidelines, historical information, similar codes, and examples of CPT 38792.

1. What is CPT 38792?

CPT 38792 is a medical procedure code that describes the injection of a radioactive tracer into the target tissues for the identification of sentinel nodes. This procedure is commonly performed in cases of melanoma or breast cancer to locate any traces of tumor draining into the sentinel node. The sentinel node is the first lymph node that cancer cells are likely to spread to from the primary tumor.

2. 38792 CPT code description

The official description of CPT code 38792 is: “Injection procedure; radioactive tracer for identification of sentinel node.”

3. Procedure

  1. The provider injects a radioactive tracer into the target tissues near the resected tumor.
  2. The provider massages the tissue to facilitate the spread of the tracer into the lymphatic system.
  3. For breast cancer sentinel node identification, the injection is made in the subareolar area of the breast.
  4. The provider examines the nodes in the target area and identifies the node that has picked up the most tracer.
  5. The removal of the primary node or nodes is reported separately.
  6. This procedure is usually performed at the time of a tumor resection.

4. Qualifying circumstances

Patients eligible to receive CPT code 38792 services are those diagnosed with melanoma or breast cancer, where the identification of sentinel nodes is crucial for determining the extent of cancer spread and planning further treatment. The procedure is typically performed during tumor resection to minimize the number of invasive procedures the patient undergoes.

5. When to use CPT code 38792

It is appropriate to bill the 38792 CPT code when the provider performs the injection procedure of a radioactive tracer for the identification of sentinel nodes in patients with melanoma or breast cancer. This code should be used in conjunction with other codes for the removal of the primary node or nodes and any additional related procedures.

6. Documentation requirements

To support a claim for CPT 38792, the following information should be documented:

  • Patient’s diagnosis (melanoma or breast cancer)
  • Indication for the sentinel node identification procedure
  • Details of the radioactive tracer injection, including the site of injection and the amount of tracer used
  • Results of the sentinel node identification, including the location and number of sentinel nodes identified
  • Any additional procedures performed in conjunction with CPT 38792, such as the removal of the primary node or nodes

7. Billing guidelines

When billing for CPT code 38792, it is essential to follow the appropriate guidelines and rules. If the provider injects multiple areas, use modifier 51 (Multiple procedures) to indicate that the same procedure was performed at separate sites. Additionally, the removal of the primary node or nodes should be reported separately using the relevant codes (e.g., 3850038542).

8. Historical information

CPT 38792 was added to the Current Procedural Terminology system on January 1, 1999. The code was changed on January 1, 2012, with the previous descriptor being “Injection procedure; for identification of sentinel node.”

9. Similar codes to CPT 38792

Five similar codes to CPT 38792 and how they differentiate are:

  1. CPT 38500 – This code refers to the biopsy or excision of lymph nodes, which is a separate procedure from the injection of the radioactive tracer.
  2. CPT 38542 – This code is used for the complete removal of lymph nodes, whereas CPT 38792 is for the identification of sentinel nodes only.
  3. CPT 78195 – This code is used for nuclear medicine lymphatics and lymph gland imaging, which is a different diagnostic procedure than the injection of a radioactive tracer.
  4. CPT 38900 – This code is for intraoperative identification (e.g., mapping) of sentinel lymph nodes, including the injection of non-radioactive dye, which is a different method than using a radioactive tracer.
  5. CPT 99201 – This code is unrelated to sentinel node identification and refers to an office or other outpatient visit for the evaluation and management of a new patient.

10. Examples

Here are 10 detailed examples of CPT code 38792 procedures:

  1. A patient with breast cancer undergoes a lumpectomy, and the provider injects a radioactive tracer to identify the sentinel node for further evaluation.
  2. A melanoma patient has a wide local excision, and the provider uses a radioactive tracer to locate the sentinel node to determine if the cancer has spread to the lymphatic system.
  3. A patient with breast cancer has a mastectomy, and the provider injects a radioactive tracer to identify the sentinel node for possible lymph node dissection.
  4. A patient with melanoma undergoes a sentinel lymph node biopsy, and the provider injects a radioactive tracer to identify the sentinel node before the biopsy.
  5. A breast cancer patient has a partial mastectomy, and the provider uses a radioactive tracer to locate the sentinel node for further evaluation and possible removal.
  6. A melanoma patient has a sentinel lymph node dissection, and the provider injects a radioactive tracer to identify the sentinel node before the dissection.
  7. A patient with breast cancer undergoes a lumpectomy and sentinel lymph node biopsy, and the provider injects a radioactive tracer to identify the sentinel node before the biopsy.
  8. A melanoma patient has a wide local excision and sentinel lymph node biopsy, and the provider uses a radioactive tracer to locate the sentinel node before the biopsy.
  9. A breast cancer patient has a mastectomy and sentinel lymph node dissection, and the provider injects a radioactive tracer to identify the sentinel node before the dissection.
  10. A melanoma patient undergoes a sentinel lymph node biopsy and lymph node dissection, and the provider uses a radioactive tracer to locate the sentinel node before the procedures.

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