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Coding for SLN procedures: 2019 changes for staff use | David O. Holtz, MD

Coding ToolsCoding
Jan 10, 2019

David O. Holtz, MD

Starting Jan. 1, 2019, there will be changes to the parenthetical statement under CPT code +38900 regarding the CPT codes that it can be billed with for intraoperative identification (e.g., mapping) of sentinel lymph nodes (SLN) for gynecologic malignancies and a new CPT code for biopsy of inguinofemoral nodes. These 2019 coding changes will affect how you bill for lymph node dissections. These changes are based on the work of the SGO Coding Taskforce and the American College of Obstetricians and Gynecologists (ACOG) Committee on Health Economics and Coding.

Previously, CPT code +38900 was restricted to procedures usually done for a diagnosis of breast cancer or melanoma and restricted from being billed with CPT codes for hysterectomies and vulvectomies. Given the acceptance of sentinel lymph node biopsy for vulvar cancer and endometrial cancer as seen in changes to the National Comprehensive Cancer Network (NCCN) guidelines over the past several years, this seemed like a good time to update the list of codes that CPT code +38900 could be billed with as supported by these NCCN guidelines.

Prior to Jan. 1, 2019, gynecologic oncologists would have to use one of the open or laparoscopic lymph node sampling codes by themselves to bill for a sentinel lymph node dissection for endometrial or vulvar cancer.  These codes all pay approximately 3.0 work relative value units (wRVUs) less than lymphadenectomy procedures (see table below).  The ability to bill for the injection of dye makes up for the difference in work and allows for the facility to bill for the dye.

A new code has also been added that allows us to properly bill for the work performed during a groin dissection for sentinel lymph node biopsy. CPT 38531 (biopsy or excision of lymph node(s); open, inguinofemoral node(s)) was created as an intermediate code between a simple open biopsy of the lymph node (CPT 38500) and more complex total lymph node dissections.

The new code CPT 38531 is intended to be used with the 38900 add on code, can be billed for just unilateral lymph nodes or used twice for bilateral lymph nodes. It can be billed at the time of a radical vulvectomy or as a subsequent separate procedure.  This code cannot be billed with more extensive lymphadenectomy codes or any of the radical vulvectomy codes that already incorporate lymph node dissection (i.e. 38760, 38765, or 56631-56640).

The permission from CMS to use the add on injection code for sentinel lymph node identification (+38900) along with the additional inguinofemoral lymph node dissection code (38531) will allow us to continue to be compensated for work as we transition toward sentinel lymph nodes in gynecologic malignancies.

David O. Holtz, MD, is a gynecologic oncologist with Lankenau Hospital in Wynnewood, PA.

CPT Code Description 2019 wRVU
38570 Laparoscopy, surgical; with retroperitoneal lymph node sampling 8.49
+38900 Intraoperative identification (e.g., mapping) of sentinel lymph nodes 2.50 x 2(if bilateral)

VS.

38571 Laparoscopy, surgical; with bilateral total pelvic lymphadenectomy 12.00
56630 Vulvectomy, radical, partial 14.80
38531 Biopsy or excision of lymph nodes, inguinofemoral node 6.74
+38900 Intraoperative identification (e.g., mapping) of sentinel lymph nodes 2.50

VS

56631 Vulvectomy, radical, partial; with unilateral inguinofemoral lymphadenectomy 18.99

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