Three significant changes that will affect reimbursement rates go into effect January 1, 2026:
Conversion factor changes
Relative Value Unit (RVU) efficiency adjustment
Practice Expense changes
If you're a Find-A-Code subscriber, there's no need to worry. Find-A-Code's fee calculators are ready for the change. You can count on Find-A-Code for the most complete and accurate information you need as a medical coder/biller.
Question: When the surgeon removes lymph nodes during a partial mastectomy, may we report the mastectomy using 19160 and the lymph excision separately using 38745?Kentucky SubscriberAnswer: Often, 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...
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