Forum - Questions & Answers

May 5th, 2015 - rlim 2 

Use of 38792 and 38900

Hello,
Can we code 38792 and 38900 together on the same day for this procedure? The doctor did……

Wide Excision primary melanoma site, left preauricular region
Intraoperative lymphatic mapping
Left cervical VA sentinel lymph node dissection
Left cervical II sentinel lymph node dissection
Left intrparotid sentinel lymp node dissection

The codes being given for these procedure is….
38520
38520
38520
11643
38792
38900
38900
38900
Are these codes correct? Please advise.

Thank you.

May 5th, 2015 - petunia 195 

re: Use of 38792 and 38900

They are considered bundled but a 59 modifier can be added if the documentation supports it.

May 5th, 2015 - rlim 2 

re: Use of 38792 and 38900

Like what kind of documentation? The doctor always starts the report by stating the patient underwent preoperative lymphoscintigraphy.....then under general anesthesia, a lymphazurin was injected intradermally around the primary melanoma....
Please advise.
Thanks.

May 5th, 2015 - petunia 195 

re: Use of 38792 and 38900

Modifier 59 or the XS,XE,XU, or XP modifiers are supported by

Separate structure, Separate Encounter, Separate Practitioner, or Unusual non overlapping 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.

Hope this helps some.

May 5th, 2015 -

re: Use of 38792 and 38900

38900 is identified in your CPT® book as an add on code which means it cannot be billed by itself seperatly. There fore you have to have a primary code to bill with first such as 38792. It should not need a modifier 59 as stated 38900 is an add on code and add on codes do not need modifiers as long as they are being billed with the code that coralates with it. Please read the 2015 CPT® book on page 175 and it will explain the correct way to bill 38900!!

May 5th, 2015 - petunia 195 

re: Use of 38792 and 38900

Code 38900(column 1) has a CCI conflict with code 38792(column 2). A modifier is allowed to override this relationship.

Please see the edit above. There is a conflict with these two codes billed together. The primary codes listed to bill for 38900 are 19302,19307,38500,38510,38520,38525,38530,38542,38740, and 38745. In your case 38520 is billed as the primary code for 38900.

Our coding tips section:

As an add-on code, 38900 is not subject to multiple procedure rules. No reimbursement reduction or modifier 51 is applied. Add-on codes describe additional intra-service work associated with the primary procedure. They are performed by the same physician on the same date of service as the primary service/procedure, and must never be reported as a stand-alone code. Report 38900 in conjunction with 19302, 19307, 38500, 38510, 38520, 38525, 38530, 38542, 38740, and 38745. For injection of radioactive tracer for identification of sentinel node, see 38792.

A modifier will still be needed since 38900 and a CCI conflict with 38792.

May 5th, 2015 -

re: Use of 38792 and 38900

I stand corrected with the modifier 59, but in CPT® is also states that: for injection of radioactive tracer for identification sentinel node, use 38792 which is right under the defintion of CPT® code 38900. I guess I'm curiouse why this would throw up a CCI edit with that being stated:)

May 5th, 2015 - rlim 2 

re: Use of 38792 and 38900

So 38792 is included with 38900? I understand 38900 is an add on code so I can use it with 38520 which I am using on this case. But as additional question related to 38900, can we use it multiple times on the same day when multiple 38520 is used?
Thank you.



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