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). 

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.

Radiofrequency Ablation - Liver

Radiofrequency Ablation

Radiofrequency ablation is a technology used in radiology for the treatment of primary and metastatic tumors.

The procedure involves placement of a needle into the tumor with adherence to impedance protocols to determine how long to transmit Radiofrequency energy into the tumor to destroy it completely.

CPT 47382 - Ablation, 1 or more liver tumors, percutaneous, radiofrequency 

For imaging guidance and monitoring, see 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 uses imaging guidance, such as CT, MRI, or ultrasound, to locate the site of the tumor. he places a radiofrequency needle electrode into the tumor in the liver. he applies electrical energy that causes the tissue to heat to a high temperature. This heat leads to destruction of the tumor. he may treat one or more tumors at the session. Scar tissues take over the tumor cells and lead to repair. After completing the destruction process, the physician withdraws the needle from the liver.

If the physician uses a laparoscopic approach, then use CPT 47370 

CPT 47370 - Laparoscopy, surgical, ablation of 1 or more liver tumors, radiofrequency 

Imaging guidance, use CPT 76940 

Procedure Description:

The patient is prepped and anesthetized, the physician makes a small incision in the umbilicus or right upper abdomen and inserts a laparoscope. then the physician examines the structures surrounding the liver. he uses this opening to insufflate or blow gas into the abdomen. This insufflation lifts the abdominal wall away from the organs and improves visualization of the site of interest. he makes additional small incisions and inserts a camera and instruments to perform the procedure. Once he enters the abdomen and has good visualization of the cavity, the physician identifies the tumor site in the liver and performs a biopsy. he introduces a radiofrequency ablation probe into the tumor and applies electrical energy that causes the tissue to heat to a high temperature. This heat leads to destruction of the tumor. Then he removes the probe, checks for bleeding, and closes the incisions with sutures in layers.

If the physician performs Open liver RF ablation - Use CPT 47380

CPT 47380 - Ablation, open, of 1 or more liver tumors, radiofrequency 

Imaging guidance, use 76940

Procedure Description:

The patient is prepped and anesthetized, the physician makes an incision in the upper abdomen and dissects the structures surrounding the liver to locate the exact site of the tumor. He performs a biopsy of the affected tissues and sends them to pathology for further analysis. The physician introduces a radiofrequency ablation probe into the tumor and applies electrical energy that causes the tissue to heat to a high temperature. This heat leads to destruction of the tumor. he removes the probe and checks for bleeding and closes the incision in the abdomen with sutures in layers.

If the physician performs liver cryoablation Then use CPT  47381 or 47371 based on the procedure.