CPT® Code 0351T

Official Description

Optical coherence tomography of breast or axillary lymph node, excised tissue, each specimen; real-time intraoperative

Common Language Description

Optical coherence tomography (OCT) is a sophisticated, non-invasive imaging technique that provides high-resolution images of the microscopic structures within breast tissue and axillary lymph nodes during surgical procedures. This advanced imaging modality employs near-infrared light to capture detailed images in real-time, allowing for the differentiation between lymphatic tissue and adipose (fat) tissue. By visualizing the intricate architecture of lymph nodes, including features such as germinal centers and intranodal lymph and blood vessels, OCT plays a crucial role in identifying the presence of metastatic disease. The intraoperative application of OCT is particularly beneficial in breast cancer surgeries, as it can significantly reduce the number of non-diseased lymph nodes that are excised. This reduction not only minimizes the risk of complications, such as lymphedema, but also aids in monitoring tumor margins, which is essential for conserving healthy breast tissue during surgical removal. Consequently, this technique can lead to less extensive breast reconstruction procedures. The CPT® Code 0351T specifically designates the real-time intraoperative use of optical coherence tomography for excised breast or axillary lymph node tissue specimens.

1. Indications

Optical coherence tomography (OCT) is indicated for use during surgical procedures involving breast tissue and axillary lymph nodes. The primary indications for this procedure include:

Breast Cancer Surgery The procedure is performed to assist in the identification of metastatic disease within lymph nodes and to evaluate tumor margins during breast cancer surgeries.
Assessment of Lymph Node Involvement OCT is utilized to differentiate between lymphatic and adipose tissue, which is critical for determining the extent of lymph node involvement in cancer.
Minimization of Surgical Complications The use of OCT can help reduce the number of non-diseased lymph nodes excised, thereby decreasing the risk of complications such as lymphedema.

2. Procedure

The procedure for optical coherence tomography of breast or axillary lymph node excised tissue involves several key steps:

Preparation of the Surgical Site The surgical area is prepared, and the patient is positioned appropriately for the procedure. This may involve the administration of anesthesia, depending on the surgical context.
Excising the Tissue Specimen The surgeon excises the breast tissue or axillary lymph node that is to be evaluated. This specimen is then prepared for imaging using OCT.
Application of Optical Coherence Tomography The OCT device is employed to capture real-time images of the excised tissue. The high-resolution imaging allows for the visualization of microscopic structures, enabling the differentiation of lymphatic tissue from adipose tissue.
Analysis of Imaging Results The images obtained through OCT are analyzed to identify any signs of metastatic disease and to assess the integrity of tumor margins. This analysis is crucial for making informed decisions regarding further surgical intervention.

3. Post-Procedure

After the optical coherence tomography procedure, the surgical team will monitor the patient for any immediate complications related to the surgery. The results from the OCT imaging will be documented, and the findings will be used to guide any further surgical decisions. Patients may require follow-up appointments to discuss the results and any additional treatment options. It is essential to provide appropriate post-operative care to ensure optimal recovery and to address any potential complications that may arise from the surgery.

Short Descr	INTRAOP OCT BRST/NODE SPEC
Medium Descr	INTRAOP OCT BREAST OR AXILL NODE EACH SPECIMEN
Long Descr	Optical coherence tomography of breast or axillary lymph node, excised tissue, each specimen; real-time intraoperative
Status Code	Carriers Price the Code
Global Days	YYY - Carrier Determines Whether Global Concept Applies
PC/TC Indicator (26, TC)	9 - Not Applicable
Multiple Procedures (51)	9 - Concept does not apply.
Bilateral Surgery (50)	9 - Concept does not apply.
Physician Supervisions	09 - Concept does not apply.
Assistant Surgeon (80, 82)	9 - Concept does not apply.
Co-Surgeons (62)	9 - Concept does not apply.
Team Surgery (66)	9 - Concept does not apply.
Diagnostic Imaging Family	99 - Concept Does Not Apply
APC Status Indicator	Items and Services Packaged into APC Rates
ASC Payment Indicator	Packaged service/item; no separate payment made.
Berenson-Eggers TOS (BETOS)	I1C - Standard imaging - breast
MUE	5

59	Distinct procedural service: under certain circumstances, it may be necessary to indicate that a procedure or service was distinct or independent from other non-e/m services performed on the same day. modifier 59 is used to identify procedures/services, other than e/m services, that are not normally reported together, but are appropriate under the circumstances. documentation must support a different session, different procedure or surgery, different site or organ system, separate incision/excision, separate lesion, or separate injury (or area of injury in extensive injuries) not ordinarily encountered or performed on the same day by the same individual. however, when another already established modifier is appropriate it should be used rather than modifier 59. only if no more descriptive modifier is available, and the use of modifier 59 best explains the circumstances, should modifier 59 be used. note: modifier 59 should not be appended to an e/m service. to report a separate and distinct e/m service with a non-e/m service performed on the same date, see modifier 25.
LT	Left side (used to identify procedures performed on the left side of the body)
RT	Right side (used to identify procedures performed on the right side of the body)