PQRS Measure
#264Sentinel Lymph Node Biopsy for Invasive Breast Cancer
This measure may be submitted via Registry only
The following codes apply for this PQRS measure:
CPT Codes | |||
| Code | Modifier | POS | Description |
|---|---|---|---|
| 19302 | N/A | N/A | Mastectomy, partial (eg, lumpectomy, tylectomy, quadrantectomy, segmentectomy); with axillary lymphadenectomy |
| 19307 | N/A | N/A | Mastectomy, modified radical, including axillary lymph nodes, with or without pectoralis minor muscle, but excluding pectoralis major muscle |
| 38500 | N/A | N/A | Biopsy or excision of lymph node(s); open, superficial |
| 38510 | N/A | N/A | Biopsy or excision of lymph node(s); open, deep cervical node(s) |
| 38520 | N/A | N/A | Biopsy or excision of lymph node(s); open, deep cervical node(s) with excision scalene fat pad |
| 38525 | N/A | N/A | Biopsy or excision of lymph node(s); open, deep axillary node(s) |
| 38530 | N/A | N/A | Biopsy or excision of lymph node(s); open, internal mammary node(s) |
| 38542 | N/A | N/A | Dissection, deep jugular node(s) |
| 38740 | N/A | N/A | Axillary lymphadenectomy; superficial |
| 38745 | N/A | N/A | Axillary lymphadenectomy; complete |
| 38900 | N/A | N/A | 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) |
HCPCS Codes | |||
| Code | Modifier | POS | Description |
| G8878 | N/A | N/A | Sentinel lymph node biopsy procedure performed |
| G8879 | N/A | N/A | Clinically node negative (t1n0m0 or t2n0m0) invasive breast cancer |
| G8880 | N/A | N/A | Documentation of reason(s) sentinel lymph node biopsy not performed (e.g., reasons could include but not limited to; non-invasive cancer, incidental discovery of breast cancer on prophylactic mastectomy, incidental discovery of breast cancer on reduction mammoplasty, pre-operative biopsy proven lymph node (ln) metastases, inflammatory carcinoma, stage 3 locally advanced cancer, recurrent invasive breast cancer, clinically node positive after neoadjuvant systemic therapy, patient refusal after informed consent, patient with significant age, comorbidities, or limited life expectancy and favorable tumor; adjuvant systemic therapy unlikely to change) |
| G8881 | N/A | N/A | Stage of breast cancer is greater than t1n0m0 or t2n0m0 |
| G8882 | N/A | N/A | Sentinel lymph node biopsy procedure not performed, reason not given |
| G8879 | N/A | N/A | Clinically node negative (t1n0m0 or t2n0m0) invasive breast cancer |
ICD9 Codes | |||
| Code | Modifier | POS | Description |
| 174.0 | N/A | N/A | Malignant neoplasm of nipple and areola of female breast |
| 174.1 | N/A | N/A | Malignant neoplasm of central portion of female breast |
| 174.2 | N/A | N/A | Malignant neoplasm of upper-inner quadrant of female breast |
| 174.3 | N/A | N/A | Malignant neoplasm of lower-inner quadrant of female breast |
| 174.4 | N/A | N/A | Malignant neoplasm of upper-outer quadrant of female breast |
| 174.5 | N/A | N/A | Malignant neoplasm of lower-outer quadrant of female breast |
| 174.6 | N/A | N/A | Malignant neoplasm of axillary tail of female breast |
| 174.8 | N/A | N/A | Malignant neoplasm of other specified sites of female breast |
| 174.9 | N/A | N/A | Malignant neoplasm of breast (female), unspecified |
| 175.0 | N/A | N/A | Malignant neoplasm of nipple and areola of male breast |
| 175.9 | N/A | N/A | Malignant neoplasm of other and unspecified sites of male breast |
Legend:
ClaimThis measure can be submitted via claim. Use the 'Data Collection' pdf associated with the measure.
GroupThis measure can be submitted through one or more groups. Click on the group name to view the group information.
RegistryThis measure can be submitted through registry.
EHRThis measure can be submitted via Electronic Health Record (EHR).
GPRO IThis measure can be submitted via Group Practice Reporting Option 1.
GPRO IIThis measure can be submitted via Group Practice Reporting Option 2.
More information on these alternative reporting mechanisms is available at:
http://www.cms.gov/PQRS/20_AlternativeReportingMechanisms.asp.
ClaimThis measure can be submitted via claim. Use the 'Data Collection' pdf associated with the measure.
GroupThis measure can be submitted through one or more groups. Click on the group name to view the group information.
RegistryThis measure can be submitted through registry.
EHRThis measure can be submitted via Electronic Health Record (EHR).
GPRO IThis measure can be submitted via Group Practice Reporting Option 1.
GPRO IIThis measure can be submitted via Group Practice Reporting Option 2.
More information on these alternative reporting mechanisms is available at:
http://www.cms.gov/PQRS/20_AlternativeReportingMechanisms.asp.
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