Mastectomy and Lymph Excision Medical Billing Tips

When the surgeon removes lymph nodes during a partial mastectomy, it may be confusing as to how to the mastectomy and the lymph excision. A common point of confusion is whether they should be bundled or reported separately.

The answer is pretty cut and dried. In most cases, with partial mastectomy, the surgeon will perform an axillary lymphadenectomy to remove the lymph nodes between the pectoralis major and the pectoralis minor muscles. The surgeon may also remove the nodes in the axilla through a separate incision at the same time.

When this occurs, you should not report the mastectomy and lymphadenectomy (38745, Axillary lymphadenectomy; complete) separately. Instead, you should use a single, combined code to report the work of both procedures. CPT eliminated partial mastectomy with lymphadenectomy code 19162 for 2007 and has replaced it with 19302 (Mastectomy, partial [e.g., lumpectomy, tylectomy, quadrant-ectomy, segmentectomy]; with axillary lymphadenectomy).

With the updated CPT codes that went into effect on Jan. 1, 2007, you should report 19302 only for most combined partial mastectomy lymphadenectomy procedures. The exception to that rule will be if there is a “staged” exception: Following some partial mastectomies (19301), the surgeon may return during the postoperative period to see if there has been any lymph node involvement and, if so, may choose to remove the nodes at that time. You will want to add the lymphadenectomy as a staged procedure using 38745 with modifier 58 (Staged or related procedure or service by the same physician during the postoperative period) appended to the claim.

View all Articles by: Kathryn Etienne, CCS-P