How To Use CPT Code 38900

CPT 38900 refers to the intraoperative identification of sentinel lymph nodes using non-radioactive dye, often performed during lymph node biopsy or tumor resection. This article will cover the description, procedure, qualifying circumstances, usage, documentation requirements, billing guidelines, historical information, similar codes, and examples of CPT 38900 procedures.

1. What is CPT 38900?

CPT 38900 is a medical procedure code used to describe the intraoperative identification of sentinel lymph nodes using non-radioactive dye. This procedure is often performed during a lymph node biopsy or tumor resection to detect the presence of disease and identify the primary lymph nodes to which the tumor drains. The code is used by medical coders and billers to accurately document and bill for this specific procedure.

2. 38900 CPT code description

The official description of CPT code 38900 is: “Intraoperative identification (eg, mapping) of sentinel lymph node(s) includes injection of non-radioactive dye, when performed (List separately in addition to code for primary procedure)”.

3. Procedure

The 38900 CPT code procedure involves the following steps:

1. The patient is appropriately prepped and anesthetized.
2. The provider injects non-radioactive dye into the tissues near the target area or resected tumor.
3. The provider massages the tissue to facilitate the spread of the dye into the lymphatic system.
4. The provider examines the lymph nodes in the target area, following the path of the dye to identify the primary lymph nodes to which the tumor drains.
5. The provider removes the sentinel lymph node(s) for biopsy, which is reported separately.
6. The biopsy samples are sent to the laboratory for testing and determination of the presence of disease.

4. Qualifying circumstances

Patients eligible to receive CPT code 38900 services are those who require intraoperative identification of sentinel lymph nodes during a lymph node biopsy or tumor resection. This procedure is typically performed on patients with cancer or other diseases that may spread through the lymphatic system. The sentinel lymph nodes are the first nodes to which cancer cells are likely to spread from the primary tumor. Identifying and examining these nodes can help determine the extent of the disease and inform treatment decisions.

5. When to use CPT code 38900

It is appropriate to bill the 38900 CPT code when the provider performs intraoperative identification of sentinel lymph nodes using non-radioactive dye during a lymph node biopsy or tumor resection. This procedure is used to detect the presence of disease and identify the primary lymph nodes to which the tumor drains, helping to determine the extent of the disease and inform treatment decisions.

6. Documentation requirements

To support a claim for CPT 38900, the following information should be documented:

• Patient’s medical history and indication for the procedure.
• Details of the procedure, including the injection of non-radioactive dye and the identification of sentinel lymph nodes.
• Results of the sentinel lymph node biopsy, including the presence or absence of disease.
• Treatment decisions based on the biopsy results.
• Any complications or adverse events related to the procedure.

7. Billing guidelines

When billing for CPT code 38900, it is important to follow the appropriate guidelines and rules. As an add-on code, CPT 38900 should be reported with an appropriate primary code. The primary codes that can be used in conjunction with CPT 38900 are listed in the CPT codebook. Additionally, if the provider injects a radioactive tracer for identification of the sentinel node, CPT code 38792 should be used instead of CPT 38900.

8. Historical information

CPT 38900 was added to the Current Procedural Terminology system on January 1, 2011. There have been no updates to the code since its addition.

9. Similar codes to CPT 38900

Five similar codes to CPT 38900 and how they differentiate from CPT 38900 are:

1. CPT 38792: This code is used for the injection of radioactive tracer for identification of sentinel node, rather than non-radioactive dye.
2. CPT 38500: This code describes a biopsy or excision of lymph nodes, but does not include the intraoperative identification of sentinel lymph nodes.
3. CPT 38525: This code is used for the biopsy or excision of deep cervical lymph nodes, without the intraoperative identification of sentinel lymph nodes.
4. CPT 38740: This code describes the dissection of axillary lymph nodes, but does not include the intraoperative identification of sentinel lymph nodes.
5. CPT 38745: This code is used for the dissection of deep axillary lymph nodes, without the intraoperative identification of sentinel lymph nodes.

10. Examples

Here are 10 detailed examples of CPT code 38900 procedures:

1. A patient with breast cancer undergoes a lumpectomy and sentinel lymph node biopsy using non-radioactive dye to identify the sentinel nodes.
2. A patient with melanoma has a wide local excision of the primary tumor and sentinel lymph node biopsy using non-radioactive dye to identify the sentinel nodes.
3. A patient with head and neck cancer undergoes a neck dissection and sentinel lymph node biopsy using non-radioactive dye to identify the sentinel nodes.
4. A patient with colorectal cancer has a colectomy and sentinel lymph node biopsy using non-radioactive dye to identify the sentinel nodes.
5. A patient with lung cancer undergoes a lobectomy and sentinel lymph node biopsy using non-radioactive dye to identify the sentinel nodes.
6. A patient with gastric cancer has a gastrectomy and sentinel lymph node biopsy using non-radioactive dye to identify the sentinel nodes.
7. A patient with thyroid cancer undergoes a thyroidectomy and sentinel lymph node biopsy using non-radioactive dye to identify the sentinel nodes.
8. A patient with ovarian cancer has a salpingo-oophorectomy and sentinel lymph node biopsy using non-radioactive dye to identify the sentinel nodes.
9. A patient with endometrial cancer undergoes a hysterectomy and sentinel lymph node biopsy using non-radioactive dye to identify the sentinel nodes.
10. A patient with penile cancer has a partial penectomy and sentinel lymph node biopsy using non-radioactive dye to identify the sentinel nodes.