Radio Frequency Ablation Stay Tuned

By Suzan Hvizdash, CPC
If you ask a medical expert about the major benefits of radio frequency ablation, or RFA, the answer will probably have to do with the procedure’s minimally invasive technique, fast recovery time, and it’s a procedure that works for patients not suited for an open procedure. Ask a coder, and the reply will focus on what’s included in the package. For example, did you know most policies include the chest tubes and catheters inserted and used during the RFA procedure as part of the service, and not eligible for separate billing?
The Facts
RFA was first performed in 1996 to destroy primary and metastatic liver lesions through the use of high frequency alternating current. RFA requires only small incisions and the recovery period is much less than a more invasive surgery; a patient can leave the hospital the day after surgery. The ideal candidate for RFA is the patient with unresectable cancer tumors of about five centimeters in size, according to David Geller, M.D. a Richard L. Simmons professor of surgery and co-director at University of Pittsburgh Medical Center Liver Cancer Center.
The technology has since been expanded to include the destruction of lesions (cancerous and benign) in different body organs such as the brain, kidneys, liver, bone and lungs. RFA also can be applied to masses on nerves (example 64600), in veins (36475-36476, 36478-36479), and otolaryngology procedures (30801 and 30802). “With an aging population, many patients have significant co-existing comorbidities and pulmonary dysfunction, which may preclude lung resection,” says James D. Luketich, M.D., Samson Family Endowed chair and chief, The Heart, Lung and Esophageal Surgery Institute, University of Pittsburgh Medical Center. “RFA is an excellent option.”
The Technique
To perform the technique, a probe that looks like an umbrella that has lost its fabric topping is inserted into the organ tissue directly into the tumor. In some cases, ultrasound may be required (and is reported separately, as explained later in the article). The probe delivers radiofrequency energy in the form of an alternating current to the lesion, which is destroyed by heat and cell injury. The procedure can take between 20 minutes to two hours depending on the lesion size, the number of lesions, and the lesion’s location. Other procedures can be done at the same session; for example, a liver resection can be performed on one lobe during the same session RFA is used to destroy lesions in another lobe. The surgeon may remove additional lesions that may form after the primary RFA, and which may be found during a CT scan follow up, using the same procedure from three to six months after the initial ablation.
Coding and Billing
A physician ablating a liver lesion under CT guidance can report 47382 and 76362. The latter code, 76362, is a CT service used for the guidance and monitoring of visceral tissue ablation and the code was created to report guidance during liver RFA procedures. If the physician finds and ablates a lung mass while performing a bronchoscopy for an unrelated reason, both services may be billed. However, if the documentation indicates that the bronchoscopy was performed in relation to the lung mass, which was subsequently ablated, only the RFA may be billed. Chest tubes and catheters inserted and used during the RFA procedure are included as part of the RFA procedure, and not eligible for separate billing.
CPT 2007
The CPT manual contains numerous codes for reporting RFA, as does the HCPCS code set. (See reference box for all the codes.) Before reporting, check your payer for the codes they require since, for example, not all payers, federal and private, accept certain HCPCS codes. As always, do your research and talk with your payers and providers before selecting the most appropriate code.
20982 RFA, percutaneous, bone tumors, w/CT
32998 RFA, pulmonary tumors, unilateral
33254-33256 Open, tissue ablation, atrial reconstruction, ltd.; w/wo cardio bypass
33265-33266 Endoscopy, tissue ablation, atrial reconstruction, wo cardio bypass; limited or extensive
36475-36476 Endovenous ablation, incompetent vein, extremity, includes RFA; first, second and subsequent vein
47370 RFA, laparoscopy, liver tumor(s)
47380 RFA, open, liver tumor(s)
47382 RFA, percutaneous, liver tumor(s)
50541-50542 Laparoscopy, ablation renal; cysts or lesions
50592 RFA, percutaneous, renal tumor(s) unilateral
76940 Ultrasound guidance, parenchymal tissue ablation
77013 CT guidance, parenchymal tissue ablation
77022 MRI guidance, parenchymal tissue ablation
93650 Intracardiac catheter ablation of atrioventricular node function, atrioventricular conduction
93651 Intracardiac catheter ablation of arrhythmogenic focus, to treat fast or slow atrioventricular pathways
93652 Intracardiac catheter ablation of arrhythmogenic focus, to treat ventricular tachycardia
0088T RFA, reduction, tissue tongue base
C9716 RF to create thermal anal lesions
L8682 RF receiver, neurostimulator
L8683-L8684 RF transmitter; for use with RF receiver or sacral root neurostimulator
S2348 RFA, decompression percutaneous, intervertebral disc pulposus, lumbar
The article was reviewed by Dr. T. Clark Gamblin and Darla Efremenko, CPC
Sources: Upmclivercancercenter.com at http://www.upmclivercancercenter.com/Treatments/RadiofrequencyAblation.asp?section=Treatments

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