Radiofrequency Ablation - Renal

Radiofrequency Ablation

Radiofrequency ablation is an emerging technology used in radiology for the treatment of primary and metastatic renal (Kidney) tumors.

The Radiofrequency Ablation procedure involves placement of a needle into the tumor and sending electric energy which destroy the tumor.

In 2006, codes for percutaneous radiofrequency ablation and cryoablation for renal tumors were developed.

CPT 50592 - Ablation, 1 or more renal tumors, percutaneous, unilateral, radiofrequency

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

76940 - Ultrasound guidance for 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:

In this procedure, the physician destroys one or more kidney tumors of the right or left kidney by radiant energy of a certain frequency range using percutaneous technique. Radiofrequency uses high energy radio waves and it delivers high frequency electric currents, which produces heat to devastate tumor cells. The heat also cauterizes blood vessels which reduces the risk of bleeding. 

To perform the ablative procedure, the patient is positioned on a CT table. The CT scan is repeated several times to recognize the proper location of the tumors. Once tumor location is identified, a thin needle is implanted into the tumor to ascertain not to destroy any other major blood vessels. Once end of the needle is confirmed in the proper location, the needle is then linked to the radiofrequency generator to demolish the abnormal cells. Imaging guidance may be required to observe tumor destruction. For more than one or very large tumors, more than one needle is repositioned carefully into the multiple locations of tumors to make sure no tumor tissue is left there. Once ablation procedure is done, the needle is removed and dressing is used to cover the open area of the skin. 

For bilateral procedure, report 50592 with modifier 50 

CPT 50593 - Ablation, renal tumors, unilateral, percutaneous, cryotherapy 

Procedure Description: 

Using percutaneous technique, the physician pulverizes one or more kidney tumors of the right or left kidney by cold therapy. Cryotherapy, also known as cold therapy, uses cold to devastate the abnormal or diseased tissue. The tumor is recognized by using ultrasound, CT, or MRI guidance. First the patient is taken to the operating room and placed in the prone position in the CT or MRI scanner. Local anesthetic may be injected. The physician decides the placement of cryoprobe. The cryoprobes are then inserted into the tumors with the help of real–time ultrasound or CT fluoroscopy taking care not to destroy any other major blood vessels. The entire procedure is visualized using CT, ultrasound, or MRI. Cold is then applied for approximately 10–20 minutes. Depending upon the size and location of the tumor, the applicator may need to be re–adjusted and additional treatments administered. For more than one or very large tumors, more than one needle is repositioned carefully into the multiple locations of tumors to freeze and destroy the tissue cells. Once end of the probe confirms the proper location, the cold ablation unit gets functional and probes freeze at lower temperature. During the freeze cycle, an ice ball develops over approximately 15 minutes to cause tumor destruction. Cold therapy uses multiple freeze–thaw cycles that is initiated by replacing the argon with helium. Complete destruction typically requires two freeze/thaw cycles. Once treatment is finished, the probes are removed and dressing is used to cover the open area of the skin.

Note:

For percutaneous cryotherapy ablation, you should use Category III code 0135T. Category III codes have not been assigned relative value units and, therefore, do not have a fee schedule. Check with your carrier concerning authorization to perform this procedure and for its reimbursement for this procedure before deciding whether to use this Category III code. Keep in mind that these codes refer to the ablation of multiple lesions, cysts and tumors. Therefore, if the Urologist ablates more than one of these during the same procedure, you should report just one unit of the code.