SGO Issues Sept. 22, 2016
SGO welcomes 21 new, 22 transitioning members
Sentinel node mapping: How would you code?
SGO Coding Bootcamp to launch Sept. 28
Gynecologic Oncology September 2016
Housing and registration, call for abstracts open for 2017 SGO Winter Meeting
Since July, 21 new members joined the Society of Gynecologic Oncology and another 22 members transitioned to the next membership level. SGO congratulates the following new and transitioning members:
Transitioning Full Members
Stacey N. Akers, MD
Kerri S Bevis, MD
Okechukwu Anthony Ibeanu, MD
Gina M. Mantia-Smaldone, MD
Georgia McCann, MD
Nell Victoria Suby, MD
Meaghan Elizabeth Tenney, MD
Transitioning Candidate Members
Alaina J. Brown, MD
Lauren Baldwin, MD
Lindsay Kuroki, MD
Ingrid Ramirez Diaz, MD
Transitioning Fellow-in-Training Members
Megan Buechel, MD
James Cripe, MD
Lauren E. Dockery, MD
Alexander Melamed, MD, MPH
Haley Moss, MD
Amin Ramzan, MD
Melissa Schwartz, MD
Brandon Seagle, MD
Haller Smith, MD
Sarah Todd, MD
Tiffany Zigras, MBBS
New Allied Members
Angela Burns, MSN
Madeline Donato, MSN
Cynae Johnson, OCM, DNP
Judith A. Smith, PharmD
New Fellow-in-Training Members
Allison Marie Barrie, MD
Robert L. Dood, MD
Robert Tyler Hillman, MD
Jennifer Jorgensen, MD, MPH
Katherine LaVigne, MD
Jaron Mark, MD
Kathryn A. Mills, MD
Charles Benjamin Palmer, DO
Ilker Selcuk, MD, PhD
New Resident/Student Members
Ashley Borgstadt, DO
Stephanie Marie Leiva, MD
Karina Nieto, MD
New International Affiliate Members
Fabio Fin, MD
Daniel Sanabria, MD
Hugo Vazquez Garcia, MD
You have incorporated sentinel node mapping at the time of robotic hysterectomy into your practice. You perform cervical injection of ICG, then perform laparoscopy, identify and laparoscopically excise the sentinel nodes. How would you code?
Coding for sentinel nodes for endometrial carcinoma can be a challenge. There are two components to the procedure:
- Excision of the node(s). This is straightforward: 38570 for laparoscopic excision of single or multiple retroperitoneal nodes.
- Intraoperative identification of the sentinel node(s), which includes injection of non-radioactive dye. The injection must be performed by the surgeon so be sure to dictate it in your op note.
There is no code specifically for intraoperative identification of pelvic/paraaortic sentinel nodes. One option is to use code +38900. This is an add-on code as designated by a “+” preceding the CPT code. Each add-on code description includes a list of codes to be used in conjunction with the specific code. Add-on codes are reimbursed at their full value, without the usual reduction applied for multiple procedures. +38900 was developed for use in breast cancer and the associated codes are for node biopsies or dissections in the chest/neck/axillary regions. Some carriers will deny +38900 when billed with 38570.
If your carrier will not recognize 38900 in conjunction with a laparoscopic retroperitoneal node dissection then you will need to use an alternate method of billing. This seems like a daunting task but for such a common procedure it is definitely worth the time and effort!
Start by using code 38999 (unlisted procedure, hemic or lymphatic system). When you use an unlisted code you need to provide the carrier with a cover letter referencing an existing code and comparing that code with the surgery you performed. For example:
Since a code for retroperitoneal sentinel node mapping is not in place, 38999 (Unlisted procedure, hemic or lymphatic system) has been used in this case to address the intraoperative identification (mapping) of sentinel nodes in this patient with endometrial carcinoma (C54.2). The procedure performed is best compared with +38900: intraoperative identification (e.g., mapping) of sentinel lymph node(s) includes injection of non-radioactive dye, when performed. +38900 is an add-on code for patients undergoing sentinel node mapping associated with lymph node sampling for breast cancer and melanoma. A similar code for endometrial carcinoma does not exist at the present time, therefore 38999 is being used. Sentinel node mapping is more complex when performed for endometrial carcinoma due to the location of the injection (deep cervix vs superficial sites on skin/breast) and the location of the nodes (retroperitoneal vs. axillary or inguinal). We would estimate that there is a 50 percent increase in the time and risk for the procedure performed relative to +38900.
It is helpful to include an introductory paragraph describing use of sentinel nodes for endometrial cancer with references including the NCCN guidelines. Keep summaries short and straightforward. Your biller will need to attach your letter along with your op note each time these codes are used.
Submitted by Mary J. Cunningham, MD, Upstate Medical University, Syracuse, NY
The SGO Coding Taskforce and SGO Education will launch the 2016 Coding Webinar Series – SGO Coding Bootcamp on Wednesday, Sept. 28, on SGO Connect Ed. This three-part series is geared towards early career gynecologic oncologists to give them a strong foundation in coding procedures. All webinars will be presented live then housed on SGO Connect Ed. The topics are as follows:
- “SGO Coding Bootcamp Part I – Evaluation and Management,” on Sept. 28 at 7:00 p.m. ET/6:00 p.m. CT/4:00 p.m. PT with David Holtz, MD, and moderated by Barbara Goff, MD
- “SGO Coding Bootcamp Part II – Coding for Surgery,” on Oct. 13 at 7:00 p.m. ET/6:00 p.m. CT/4:00 p.m. PT with Eileen Segreti, MD, and moderated by Mark Shahin, MD
- “SGO Coding Bootcamp Part III – Coding Case Studies” on Nov.17 at 7:00 p.m. ET/6:00 p.m. CT/4:00 p.m. PT with Mary Cunningham, MD and Kevin Holcomb, MD
Commentary: SGO Health Policy and Socioeconomic Committee: Current and future efforts of the Future of Physician Payment Reform Taskforce and the Legislative and Regulatory Affairs Taskforce Matthew Carlson, Saketh Guntupalli, Emily Ko, Jason D. Wright
Lead Article: Case-control study of cervical cancer and gynecologic screening: A SEER-Medicare analysis Karin A. Rosenblatt, Elaina F. Osterbur, Jeffrey A. Douglas
Editorials: Cervical cancer screening in women over 65. PRO: Are we asking the right question? Laurie Elit Cervical cancer screening in women over 65. CON: Reasons for uncertainty George F. Sawaya
The call for abstracts as well as housing and registration are now open for the 2017 SGO Winter Meeting to be held Jan. 26-28, 2017, at Beaver Run Resort in Breckenridge, CO. Fellows and Residents may submit their abstract(s) through Tuesday, Nov. 8, 2016, at 11:59 p.m. Central Time.