Radiofrequency ablation - Lung

Radiofrequency ablation

Radiofrequency ablation is a medical procedure in which part of the tumor or other dysfunctional tissue is ablated using the heat generated from high frequency alternating current (in the range of 350–500 kHz). RFA is generally conducted in the outpatient setting, using either local anesthetics or conscious sedation anesthesia.

CPT 32998 - Ablation therapy for reduction or eradication of 1 or more pulmonary tumors including pleura or chest wall when involved by tumor extension, percutaneous, radiofrequency, unilateral

For imaging guidance and monitoring, see CPT 76940, 77013, 77022 

76940 - Ultrasound guidance for, and monitoring of, parenchymal tissue ablation
77013 - Computed tomography guidance for, and monitoring of, parenchymal tissue ablation
77022 - Magnetic resonance guidance for, and monitoring of, parenchymal tissue ablation

Procedure Description:
The patient is appropriately prepped and anesthetized, the physician creates a small incision in the chest wall between the ribs. he then, through this incision, introduces a needle electrode and approaches the tumor area. he uses imaging guidance for movement of the electrode to the tumor. he then applies heat to the tumor using the electrode. he repeats treatment with heat many times to ensure complete tumor destruction. he may destroy one or more tumors on one side of the body. he then withdraws the needle electrode and closes the skin incision using adhesive dressing.

This code is unilateral so use modifier 50, or follow the payer’s specific guidelines, to indicate a bilateral service.

Pleural cavity or lung biopsy procedures may be accomplished using a percutaneous, thoracoscopic (Video-Assisted Thoracoscopic Surgery [VATS]), or thoracotomy approach. They involve the removal of differing amounts of tissue for diagnosis. A biopsy may be performed using different techniques such as incision or wedge. Lung resection procedures include diagnostic and therapeutic procedures, including the removal of blebs, bullae, cysts, and benign or malignant tumors or lesions.
These procedures may involve the removal of small portions of the lung or even an entire lung.

Additionally, lung resection procedures may require the removal of adjacent structures. Both diagnostic lung biopsies and therapeutic lung resections can be performed utilizing a wedge technique. However, a diagnostic biopsy of a lung nodule using a wedge technique requires only that a tissue sample be obtained without particular attention to resection margins. A therapeutic wedge resection requires attention to margins and complete resection even when the wedge resection is ultimately followed by a more extensive resection. In the case of a wedge resection in which intraoperative pathology consultation determines that a more extensive resection is required in the same anatomic location, it becomes classified as a diagnostic wedge resection (32507, 32668). When no more extensive resection is required, the same procedure is a therapeutic wedge resection (32505, 32666).