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The CPT® Code 38900 refers to the intraoperative identification of sentinel lymph node(s), a critical procedure often utilized in surgical oncology. This process, commonly known as lymph node mapping, involves the injection of a non-radioactive dye, typically isosulfan blue, to facilitate the visualization of the sentinel lymph node during surgery. The sentinel lymph node is the first lymph node to which cancer cells are likely to spread from a primary tumor. By identifying this node, surgeons can assess whether cancer has metastasized, which is crucial for staging the cancer and determining the appropriate course of treatment. The injection of the dye is performed in the tumor bed, allowing the dye to travel through the lymphatic system to the sentinel node, where it can be easily identified. This procedure is performed in conjunction with a primary surgical procedure and is reported separately to ensure accurate coding and reimbursement for the services rendered.
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The procedure described by CPT® Code 38900 is indicated for the following conditions:
The procedure for intraoperative identification of sentinel lymph node(s) involves several key steps:
Post-procedure care following the identification of sentinel lymph node(s) typically includes monitoring the patient for any immediate complications related to the injection or biopsy. Patients may experience localized swelling or discoloration at the injection site due to the dye. Additionally, the surgical team will provide instructions regarding wound care and any signs of infection to watch for. Follow-up appointments may be scheduled to discuss biopsy results and further treatment options based on the findings.
| Short Descr | IO MAP OF SENT LYMPH NODE | Medium Descr | INTRAOP SENTINEL LYMPH NODE ID W/DYE INJECTION | Long Descr | 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) | Status Code | Active Code | Global Days | ZZZ - Code Related to Another Service | PC/TC Indicator (26, TC) | 0 - Physician Service Code | Multiple Procedures (51) | 0 - No payment adjustment rules for multiple procedures apply. | Bilateral Surgery (50) | 1 - 150% payment adjustment for bilateral procedures applies. | Physician Supervisions | 09 - Concept does not apply. | Assistant Surgeon (80, 82) | 2 - Payment restriction for assistants at surgery does not apply to this procedure... | Co-Surgeons (62) | 1 - Co-surgeons could be paid, though supporting documentation is required... | Team Surgery (66) | 0 - Team surgeons not permitted for this procedure. | Diagnostic Imaging Family | 99 - Concept Does Not Apply | APC Status Indicator | Items and Services Packaged into APC Rates | ASC Payment Indicator | Packaged service/item; no separate payment made. | Type of Service (TOS) | 2 - Surgery | Berenson-Eggers TOS (BETOS) | P1G - Major procedure - Other | MUE | 1 | CCS Clinical Classification | 67 - Other therapeutic procedures, hemic and lymphatic system |
This is an add-on code that must be used in conjunction with one of these primary codes.
| 19302 | MPFS Status: Active Code APC J1 ASC A2 Physician Quality Reporting CPT Assistant Article Illustration for Code Mastectomy, partial (eg, lumpectomy, tylectomy, quadrantectomy, segmentectomy); with axillary lymphadenectomy | 19307 | MPFS Status: Active Code APC J1 ASC G2 Physician Quality Reporting CPT Assistant Article Illustration for Code Mastectomy, modified radical, including axillary lymph nodes, with or without pectoralis minor muscle, but excluding pectoralis major muscle | 38500 | MPFS Status: Active Code APC J1 ASC A2 CPT Assistant Article Illustration for Code Biopsy or excision of lymph node(s); open, superficial | 38510 | MPFS Status: Active Code APC J1 ASC A2 CPT Assistant Article Illustration for Code Biopsy or excision of lymph node(s); open, deep cervical node(s) | 38520 | MPFS Status: Active Code APC J1 ASC A2 Illustration for Code Biopsy or excision of lymph node(s); open, deep cervical node(s) with excision scalene fat pad | 38525 | MPFS Status: Active Code APC J1 ASC A2 CPT Assistant Article Illustration for Code Biopsy or excision of lymph node(s); open, deep axillary node(s) | 38530 | MPFS Status: Active Code APC J1 ASC A2 CPT Assistant Article Illustration for Code Biopsy or excision of lymph node(s); open, internal mammary node(s) | 38531 | MPFS Status: Active Code APC J1 ASC G2 Biopsy or excision of lymph node(s); open, inguinofemoral node(s) | 38542 | MPFS Status: Active Code APC J1 ASC A2 CPT Assistant Article Illustration for Code Dissection, deep jugular node(s) | 38562 | MPFS Status: Active Code APC C CPT Assistant Article Illustration for Code Limited lymphadenectomy for staging (separate procedure); pelvic and para-aortic | 38564 | MPFS Status: Active Code APC C Illustration for Code Limited lymphadenectomy for staging (separate procedure); retroperitoneal (aortic and/or splenic) | 38570 | MPFS Status: Active Code APC J1 ASC A2 CPT Assistant Article Illustration for Code Laparoscopy, surgical; with retroperitoneal lymph node sampling (biopsy), single or multiple | 38571 | MPFS Status: Active Code APC J1 ASC A2 CPT Assistant Article Illustration for Code Laparoscopy, surgical; with bilateral total pelvic lymphadenectomy | 38572 | MPFS Status: Active Code APC J1 ASC A2 CPT Assistant Article Illustration for Code Laparoscopy, surgical; with bilateral total pelvic lymphadenectomy and peri-aortic lymph node sampling (biopsy), single or multiple | 38740 | MPFS Status: Active Code APC J1 ASC A2 Physician Quality Reporting Axillary lymphadenectomy; superficial | 38745 | MPFS Status: Active Code APC J1 ASC A2 Physician Quality Reporting Axillary lymphadenectomy; complete | 38760 | MPFS Status: Active Code APC J1 ASC A2 Physician Quality Reporting CPT Assistant Article Illustration for Code Inguinofemoral lymphadenectomy, superficial, including Cloquet's node (separate procedure) | 38765 | MPFS Status: Active Code APC C Physician Quality Reporting CPT Assistant Article Illustration for Code Inguinofemoral lymphadenectomy, superficial, in continuity with pelvic lymphadenectomy, including external iliac, hypogastric, and obturator nodes (separate procedure) | 38770 | MPFS Status: Active Code APC C Physician Quality Reporting CPT Assistant Article Illustration for Code Pelvic lymphadenectomy, including external iliac, hypogastric, and obturator nodes (separate procedure) | 38780 | MPFS Status: Active Code APC C Physician Quality Reporting CPT Assistant Article Illustration for Code Retroperitoneal transabdominal lymphadenectomy, extensive, including pelvic, aortic, and renal nodes (separate procedure) | 56630 | Female Edit MPFS Status: Active Code APC C Physician Quality Reporting Illustration for Code Vulvectomy, radical, partial; | 56631 | Female Edit MPFS Status: Active Code APC C Physician Quality Reporting CPT Assistant Article Illustration for Code Vulvectomy, radical, partial; with unilateral inguinofemoral lymphadenectomy | 56632 | Female Edit MPFS Status: Active Code APC C Physician Quality Reporting CPT Assistant Article Illustration for Code Vulvectomy, radical, partial; with bilateral inguinofemoral lymphadenectomy | 56633 | Female Edit MPFS Status: Active Code APC C Physician Quality Reporting CPT Assistant Article Illustration for Code Vulvectomy, radical, complete; | 56634 | Female Edit MPFS Status: Active Code APC C Physician Quality Reporting CPT Assistant Article Vulvectomy, radical, complete; with unilateral inguinofemoral lymphadenectomy | 56637 | Female Edit MPFS Status: Active Code APC C Physician Quality Reporting CPT Assistant Article Vulvectomy, radical, complete; with bilateral inguinofemoral lymphadenectomy | 56640 | Female Edit MPFS Status: Active Code APC C Physician Quality Reporting CPT Assistant Article Illustration for Code Vulvectomy, radical, complete, with inguinofemoral, iliac, and pelvic lymphadenectomy |
| RT | Right side (used to identify procedures performed on the right side of the body) | LT | Left side (used to identify procedures performed on the left side of the body) | GC | This service has been performed in part by a resident under the direction of a teaching physician | 50 | Bilateral procedure: unless otherwise identified in the listings, bilateral procedures that are performed at the same session, should be identified by adding modifier 50 to the appropriate 5 digit code. note: this modifier should not be appended to designated "add-on" codes (see appendix d). | AS | Physician assistant, nurse practitioner, or clinical nurse specialist services for assistant at surgery | 59 | Distinct procedural service: under certain circumstances, it may be necessary to indicate that a procedure or service was distinct or independent from other non-e/m services performed on the same day. modifier 59 is used to identify procedures/services, other than e/m services, that are not normally reported together, but are appropriate under the circumstances. documentation must support a different session, different procedure or surgery, different site or organ system, separate incision/excision, separate lesion, or separate injury (or area of injury in extensive injuries) not ordinarily encountered or performed on the same day by the same individual. however, when another already established modifier is appropriate it should be used rather than modifier 59. only if no more descriptive modifier is available, and the use of modifier 59 best explains the circumstances, should modifier 59 be used. note: modifier 59 should not be appended to an e/m service. to report a separate and distinct e/m service with a non-e/m service performed on the same date, see modifier 25. | XU | Unusual non-overlapping service, the use of a service that is distinct because it does not overlap usual components of the main service | 82 | Assistant surgeon (when qualified resident surgeon not available): the unavailability of a qualified resident surgeon is a prerequisite for use of modifier 82 appended to the usual procedure code number(s). | XS | Separate structure, a service that is distinct because it was performed on a separate organ/structure | AQ | Physician providing a service in an unlisted health professional shortage area (hpsa) | 58 | Staged or related procedure or service by the same physician or other qualified health care professional during the postoperative period: it may be necessary to indicate that the performance of a procedure or service during the postoperative period was: (a) planned or anticipated (staged); (b) more extensive than the original procedure; or (c) for therapy following a surgical procedure. this circumstance may be reported by adding modifier 58 to the staged or related procedure. note: for treatment of a problem that requires a return to the operating/procedure room (eg, unanticipated clinical condition), see modifier 78. | CR | Catastrophe/disaster related | 22 | Increased procedural services: when the work required to provide a service is substantially greater than typically required, it may be identified by adding modifier 22 to the usual procedure code. documentation must support the substantial additional work and the reason for the additional work (ie, increased intensity, time, technical difficulty of procedure, severity of patient's condition, physical and mental effort required). note: this modifier should not be appended to an e/m service. | 51 | Multiple procedures: when multiple procedures, other than e/m services, physical medicine and rehabilitation services or provision of supplies (eg, vaccines), are performed at the same session by the same individual, the primary procedure or service may be reported as listed. the additional procedure(s) or service(s) may be identified by appending modifier 51 to the additional procedure or service code(s). note: this modifier should not be appended to designated "add-on" codes (see appendix d). | 52 | Reduced services: under certain circumstances a service or procedure is partially reduced or eliminated at the discretion of the physician or other qualified health care professional. under these circumstances the service provided can be identified by its usual procedure number and the addition of modifier 52, signifying that the service is reduced. this provides a means of reporting reduced services without disturbing the identification of the basic service. note: for hospital outpatient reporting of a previously scheduled procedure/service that is partially reduced or cancelled as a result of extenuating circumstances or those that threaten the well-being of the patient prior to or after administration of anesthesia, see modifiers 73 and 74 (see modifiers approved for asc hospital outpatient use). | 53 | Discontinued procedure: under certain circumstances, the physician or other qualified health care professional may elect to terminate a surgical or diagnostic procedure. due to extenuating circumstances or those that threaten the well being of the patient, it may be necessary to indicate that a surgical or diagnostic procedure was started but discontinued. this circumstance may be reported by adding modifier 53 to the code reported by the individual for the discontinued procedure. note: this modifier is not used to report the elective cancellation of a procedure prior to the patient's anesthesia induction and/or surgical preparation in the operating suite. for outpatient hospital/ambulatory surgery center (asc) reporting of a previously scheduled procedure/service that is partially reduced or cancelled as a result of extenuating circumstances or those that threaten the well being of the patient prior to or after administration of anesthesia, see modifiers 73 and 74 (see modifiers approved for asc hospital outpatient use). | 62 | Two surgeons: when 2 surgeons work together as primary surgeons performing distinct part(s) of a procedure, each surgeon should report his/her distinct operative work by adding modifier 62 to the procedure code and any associated add-on code(s) for that procedure as long as both surgeons continue to work together as primary surgeons. each surgeon should report the co-surgery once using the same procedure code. if additional procedure(s) (including add-on procedure(s) are performed during the same surgical session, separate code(s) may also be reported with modifier 62 added. note: if a co-surgeon acts as an assistant in the performance of additional procedure(s), other than those reported with the modifier 62, during the same surgical session, those services may be reported using separate procedure code(s) with modifier 80 or modifier 82 added, as appropriate. | 74 | Discontinued out-patient hospital/ambulatory surgery center (asc) procedure after administration of anesthesia: due to extenuating circumstances or those that threaten the well being of the patient, the physician may terminate a surgical or diagnostic procedure after the administration of anesthesia (local, regional block(s), general) or after the procedure was started (incision made, intubation started, scope inserted, etc). under these circumstances, the procedure started but terminated can be reported by its usual procedure number and the addition of modifier 74. note: the elective cancellation of a service prior to the administration of anesthesia and/or surgical preparation of the patient should not be reported. for physician reporting of a discontinued procedure, see modifier 53. | 76 | Repeat procedure or service by same physician or other qualified health care professional: it may be necessary to indicate that a procedure or service was repeated by the same physician or other qualified health care professional subsequent to the original procedure or service. this circumstance may be reported by adding modifier 76 to the repeated procedure or service. note: this modifier should not be appended to an e/m service. | 77 | Repeat procedure by another physician or other qualified health care professional: it may be necessary to indicate that a basic procedure or service was repeated by another physician or other qualified health care professional subsequent to the original procedure or service. this circumstance may be reported by adding modifier 77 to the repeated procedure or service. note: this modifier should not be appended to an e/m service. | 78 | Unplanned return to the operating/procedure room by the same physician or other qualified health care professional following initial procedure for a related procedure during the postoperative period: it may be necessary to indicate that another procedure was performed during the postoperative period of the initial procedure (unplanned procedure following initial procedure). when this procedure is related to the first, and requires the use of an operating/procedure room, it may be reported by adding modifier 78 to the related procedure. (for repeat procedures, see modifier 76.) | 79 | Unrelated procedure or service by the same physician or other qualified health care professional during the postoperative period: the individual may need to indicate that the performance of a procedure or service during the postoperative period was unrelated to the original procedure. this circumstance may be reported by using modifier 79. (for repeat procedures on the same day, see modifier 76.) | 80 | Assistant surgeon: surgical assistant services may be identified by adding modifier 80 to the usual procedure number(s). | 81 | Minimum assistant surgeon: minimum surgical assistant services are identified by adding modifier 81 to the usual procedure number. | AG | Primary physician | AI | Principal physician of record | CC | Procedure code change (use 'cc' when the procedure code submitted was changed either for administrative reasons or because an incorrect code was filed) | GV | Attending physician not employed or paid under arrangement by the patient's hospice provider | GW | Service not related to the hospice patient's terminal condition | GY | Item or service statutorily excluded, does not meet the definition of any medicare benefit or, for non-medicare insurers, is not a contract benefit | GZ | Item or service expected to be denied as not reasonable and necessary | KX | Requirements specified in the medical policy have been met | PD | Diagnostic or related non diagnostic item or service provided in a wholly owned or operated entity to a patient who is admitted as an inpatient within 3 days | Q0 | Investigational clinical service provided in a clinical research study that is in an approved clinical research study | Q1 | Routine clinical service provided in a clinical research study that is in an approved clinical research study | Q6 | Service furnished under a fee-for-time compensation arrangement by a substitute physician or by a substitute physical therapist furnishing outpatient physical therapy services in a health professional shortage area, a medically underserved area, or a rural area | SA | Nurse practitioner rendering service in collaboration with a physician | SG | Ambulatory surgical center (asc) facility service | X3 | Episodic/broad services: for reporting services by clinicians who have broad responsibility for the comprehensive needs of the patient that is limited to a defined period and circumstance such as a hospitalization; reporting clinician service examples include but are not limited to the hospitalist's services rendered providing comprehensive and general care to a patient while admitted to the hospital | X4 | Episodic/focused services: for reporting services by clinicians who provide focused care on particular types of treatment limited to a defined period and circumstance; the patient has a problem, acute or chronic, that will be treated with surgery, radiation, or some other type of generally time-limited intervention; reporting clinician service examples include but are not limited to, the orthopedic surgeon performing a knee replacement and seeing the patient through the postoperative period | XE | Separate encounter, a service that is distinct because it occurred during a separate encounter | XP | Separate practitioner, a service that is distinct because it was performed by a different practitioner |
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| 2011-01-01 | Added | Added |