Oncology & Hematology Coding Alert

Question: Our radiation oncologist performed a computed tomography (CT)-guided lung tumor ablation. Does a specific code describe this service? We are leaning toward the unlisted-procedure code (32999), but we'd rather avoid it because Medicare does not reimburse for unlisted procedures.

Louisiana Subscriber

Answer: Medicare reimburses practices for unlisted procedures. If you report an unlisted-procedure code, such as 32999 (Unlisted procedure, lungs and pleura), you should send a paper claim with a copy of the operative report or chart notes and a short letter comparing the procedure that the oncologist performed to a similar procedure, such as 76362 (Computerized axial tomographic guidance for, and monitoring of, tissue ablation), which has relative units assigned to it.
 
Reporting a similar procedure explains why you deserve the same amount of reimbursement that the comparable established code commands. In your letter, describe how long it took your physician to perform the procedure, the number of medical personnel who completed the surgery, and the level of complexity involved.
 
If your radiation oncologist performed a radiofrequency ablation, you should report 32999, along with 76362 for the CT guidance.
 
If your physician performs this procedure often, consider meeting with your carrier's medical director as well as the medical directors for your non-governmental insurers. Describe the procedure, arrange for its coverage, and negotiate a mutually agreeable free in advance. This way, when you submit the unlisted-procedure code with the report and approved ICD-9 codes, the claim will not undergo an individual review, but your carrier will approve the claim.
 
Medicare carriers consider radiofrequency ablation for destroying tumor cells an investigational service, so make sure your patients sign an advance beneficiary notice (ABN) before your physician performs that procedure.