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Radiology Coding Alert

Reader Questions:
Report 32999 for Lung Tumor Ablation

Question: Our interventional radiologist performed a CT-guided lung tumor ablation. Does a specific code describe this service? We are leaning toward the unlisted-procedure code (32999), but wed rather not use it because Medicare does not reimburse for unlisted procedures.

Tennessee Subscriber
 
 Answer: Medicare reimburses practices for unlisted procedures it just takes a bit more effort to submit these claims than those with more specific codes.
    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 you performed to a similar procedure that has relative value units (RVUs) assigned to it.
 
These demonstrate to the carrier why you deserve the same amount of reimbursement that the comparable established code commands. In your letter, describe how much time the physician spent performing the procedure, the number of medical personnel required to complete the surgery, and the level of complexity involved.
  If you performed a radiofrequency ablation, you should report 32999, along with 76362 (Computerized axial tomographic guidance for, and monitoring of, tissue ablation) for the CT guidance.
 
If you perform this procedure often, you should be proactive and meet with your carrier medical director as well as the medical directors for the non-governmental insurers for which you most frequently provide services. Describe the procedure, arrange for its coverage, and negotiate a mutually agreeable allowable fee in advance.  This way, when you submit the unlisted-procedure code with the report and the agreed-upon ICD-9 codes, the claim will not undergo an individual review, but instead will be approved by local policy and will be paid as agreed.


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