Radiology Coding Alert

In 2002, CPT Codes approved three new codes for radiofrequency ablation (RFA) of the liver - 47370, 47380, 47382. When employing these new procedural codes, radiology coders should understand that they can't use an RFA code more than once per operative session, even if the RFA has removed more than one tumor. In many primary and metastatic liver cancer cases, certain individual tumors cannot be surgically removed for various reasons including tumor location and/or multiplicity, residual hepatic function, and patient operative risk factors. RFA destroys metastatic tumors quickly and effectively - without surgery. And there's one more reason to celebrate: Medicare and many other payers now reimburse for RFA. RFA destroys soft tissue cells through heat derived from radiofrequency energy generated by an alternating electrical current. It's just like "cooking the lesion," says Jeff Fulkerson, BA, CPC, coding specialist at the Emory Clinic in Atlanta. Code Preprocedure E/M Separately Don't lose sight of the fact that when using the RFA codes, you can use a separate E/M code to bill for the visit that leads to the RFA. Suppose a patient presented with two separate liver lesions measuring 2 cm x 2 cm and 4 cm x 4 cm. Because the lesions' locations precluded surgery, the patient's oncologist referred him to an interventionalist for evaluation. The interventionalist recommended RFA as the most amenable treatment. In this case, you would code the evaluation separately using the E/M level most appropriate to describe the history, physical examination, review of medical records and images, and medical decision-making. 47382 Most Commonly Used RFA Code Although CPT 2002 contains three new procedural RFA codes (open, laparoscopic and percutaneous), interventionalists will primarily use the percutaneous variant, 47382 (Ablation, one or more liver tumor[s], percutaneous, radiofrequency), Fulkerson says. The number of ablative passes depends on the number and size of the tumors treated. The procedure usually lasts between 30 minutes and two hours, and the patient typically goes home the same day. Should hospitalization be needed, the admitting physician (typically the interventionalist) may code further E/M services. The most important thing to understand about 47382, Fulkerson emphasizes, is that the ablation covers one or more tumors during the same operative session. "No matter how many tumors the physician has to treat during that operative session, and no matter how long the procedure lasted, you may submit CPT 47382 only once." If the patient needs to return for serial treatments on more than one date of service, coders may use the code again for those additional treatment sessions. RFA can also be performed during an abdominal operation or by using a laparoscopic approach, for which codes 47380 (Ablation, open, of one or more liver tumor[s]; radiofrequency) and 47370 (Laparoscopy, surgical, [...]