tci General Surgery Coding Alert - 2004 Issue 12

CMS Revises Mastectomy and Sentinel Node Biopsy Policy

NCCI 10.3 instructs surgeons to report 38500, 38525-38530 with 19160If you've strictly adhered to CMS' recommendation to report 38740 (Axillary lymphadenectomy; superficial) for sentinel node biopsy in conjunction with partial mastectomy 19160 (Mastectomy, partial), get ready to adjust your coding. The latest edition of the National Correct Coding Initiative (NCCI) contains revised text instructing surgeons to report excision codes 38500 or 38525-38530, as appropriate, for sentinel node biopsy with 19160.The new text, which appears in the NCCI introduction to surgery codes 30000-39599, instructs, "sentinel lymph node biopsy is separately reported when performed prior to a localized excision...

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