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Sometimes when performing a partial mastectomy it's necessary to remove axillary lymph nodes or biopsy the sentinel node. A sentinel node is the first node in a lymphatic chain to receive fluid from the primary tumor site which contains the metastasizing cancer cells.
CPT code 19301 is reported for a partial mastectomy or lumpectomy when the tumor is removed and specific attention is paid to the surgical margins. The lymph node excision code is determined by the type of procedure performed.
There are three levels of axillary lymph nodes: Levels I-III. CPT code 38500 is reported for open excision or biopsy of superficial lymph nodes — these nodes are usually palpable under the skin. Levels II and III are deep and reported with CPT code 38525 (open, deep axillary nodes). The depth of dissection should be documented in the op note for coding accuracy.
Injection of dye to confirm a sentinel node is separately reported with CPT code 38792 (injection procedure for identification of sentinel node).
CPT code 19302 is only reported when “all identifiable axillary lymph nodes are removed” — A separate incision may be made but that is not what determines coding, reporting is based on the extent of axillary lymph node dissection.
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