Can the surgeon bill an intraoperative lymphoscintigraphy with a sentinel node biopsy?
No. Imaging services are paid only with a lymphoscintigraphy that includes images obtained in the nuclear lab, says Cindy Parman, CPC, a radiology coding and reimbursement specialist, member of the American Academy of Professional Coders’ national advisory board and president of Coding Strategies Inc. in Dallas, Ga. When the surgeon performs “intraoperative lymphoscintigraphy” using a gamma probe during the sentinel node biopsy to image a radioisotope injected earlier, the imaging is included in the biopsy excision procedure. Sentinel lymph node biopsy involves identification, removal and evaluation of lymph nodes that drain the area of a malignant tumor. Identifying the sentinel node (rather than the biopsy) often complicates coding. Two methods, or a combination of both, are used to identify a sentinel node: • lymphoscintigraphy • direct visualization of vital dye (e.g., isosulfan blue).