tci Part B Insider - 2010 Issue 32

Reader Questions: Discover True Meaning of 38792 Note

Question: The physician performed a sentinel node injection with lymphoscintigraphy. A note with 38792 states to report 78195 for imaging. So why did Medicare deny a claim that included both codes?Answer: You should report 78195 (Lymphatic and lymph nodes imaging) for this service and leave 38792 (Injection procedure; for identification of sentinel node) off the claim. The Correct Coding Initiative (CCI) edits consider 38792 and 78195 to be mutually exclusive.Helpful: CPT Assistant (December 1999) explains that imaging code 78195 includes the injection: "The injection of radioactive tracer is included in the lymphoscintigraphy procedure performed at the same...

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