# Alcohol ablation-which code would you use?



## margaret fahy (Feb 25, 2014)

Hey Guys,
Do you have a code for the following?...not the FNA, but the Alcohol Ablation of the metastatic lymph node....
Don't have the size...just level 5/level 6.  Looked at codes 17270-17276..maybe..but i don't know the size of the lymph node...or 38999?
All input is welcome...thanks...Margie

PERCUTANEOUS FINE NEEDLE ASPIRATION OF LYMPH NODE

PERCUTANEOUS ALCOHOL ABLATION OF METASTATIC LYMPH NODE UNDER
ULTRASOUND GUIDANCE

CLINICAL HISTORY: s/p thyroidectomy, history of papillary
carcinoma, 196.0: Secondary and unspecified malignant neoplasm of
lymph nodes of head, face, and neck(196.0).  

PROCEDURE: Limited ultrasound of the neck showed the presence of
a well defined lymph node at level 5/level 6 on the left side.
This lymph node was seen just medial to the left common carotid
artery.  
The skin of the neck was prepped and draped in sterile fashion.

The procedure was performed in 2 stages.  The first portion was
fine needle aspiration for confirmation of metastasis and the
second was alcohol ablation of the involved node.

Under ultrasound guidance a 27G needle was used and fine needle
aspiration was performed on the lymph node.

On table diagnosis of a metastatic lymph node was made by the
cytopathologist from....
Once the diagnosis was made, alcohol ablation was carried out.

Since the metastatic lymph node was adjacent the carotid artery,
initially under ultrasound guidance, lidocaine was injected
around the lymph node and by injecting lidocaine, the carotid
artery was displaced more laterally from the metastatic lymph
node.

Under ultrasound guidance, a 27G needle was passed into the
metastatic lymph node and 0.1-0.2 mL of absolute alcohol was
injected into the gland.  Acute increase in echogenicity was
noted around the injection site related to microbubble formation
(alcohol induced tissue damage).  Around 4-5 injections were made
in different regions of the node and a total of 0.6 mL of alcohol
was injected.

No definite extravasation was noted.   

There were no complications and the patient left the IR suite in
stable condition. Dr. was present for the entire
procedure.

FINDINGS: Limited ultrasound of the neck demonstrated a lymph
node at level 5/level 6 junction on the left side.

Permanent ultrasound images were obtained and stored in the PACS
system.

IMPRESSION

Successful fine needle aspiration of the left level 5/level 6
lymph node.
Successful confirmation of metastatic involvement on
cytopathology.
Successful alcohol ablation of the metastatic lymph node under
ultrasound guidance.


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## k030876 (Jun 27, 2014)

*Answer?Alcohol Ablation Lymph Node*

Did you ever get an answer? I'm looking at code 20500?


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## margaret fahy (Jun 30, 2014)

HI,
We went withe the unlisted Lymph code..38999...and determined a fee...i believe it was determined that this is what the guidelines said....


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