Ask Dr. Z

We have had several recent cases in which our IR physicians perform both US-guided percutaneous RF ablation of a hepatic mass as well as US-guided percutaneous alcohol ablation of a separate hepatic mass or nodule during the same session. Instruction #2 on page 556 of your 2021 Interventional Radiology Coding Reference states, "Report unlisted code 47399 for direct needle injection of alcohol for ablation of hepatic neoplasm." Since both RFA and alcohol ablation are being performed percutaneously on the same day, should we code only as 47399, along with a description that both RFA and alcohol ablation were used? Or should we use only 47382 since that code includes more than one tumor and RFA was performed? (We are aware that we can bill separately for the imaging/US.) See physician's impression below; the procedures were appropriately documented in detail.

IMPRESSION:

//Radiofrequency ablation of the 3.7 cm right hepatic mass.

//Ultrasound-guided alcohol ablation of a right hepatic 1.2 cm dysplastic nodule.