CPT® Code 32998

Ablation therapy for reduction or eradication of 1 or more pulmonary tumor(s) including pleura or chest wall when involved by tumor extension, percutaneous, including imaging guidance when performed, unilateral; radiofrequency

Percutaneous radiofrequency tumor ablation therapy is a minimally invasive procedure aimed at the reduction or complete eradication of one or more pulmonary tumors. This procedure is specifically designed for tumors located in the lungs, and it may also involve the pleura or chest wall if these structures are affected by tumor extension. The term "percutaneous" indicates that the procedure is performed through the skin, utilizing imaging guidance to enhance precision and safety. The approach taken during the procedure is determined by the tumor's location; for instance, the patient may be positioned supine (lying on their back) for anterior tumors or prone (lying on their stomach) for posterior tumors. During the procedure, grounding pads made of steel mesh are strategically placed on the patient's lower back and/or gluteal region to ensure safety and effectiveness. The use of CT scanning is critical in this process, as it assists in planning the trajectory of the needle track and determining the optimal placement of the needle for ablation. The actual ablation is performed using a 17-gauge internally cooled tip electrode needle, which is selected based on the size of the tumor. A treatment duration of twelve minutes is typically employed to ensure that the tumor volume corresponding to the diameter of the exposed, uninsulated portion of the needle undergoes complete necrotic coagulation. The procedure involves the introduction of the electrode needle into the tumor under CT guidance, with electrodes connected to a generator capable of producing an output of up to 200 watts. To prevent overheating, the tip of the electrode is cooled by infusing a saline solution through its cooling lumen during the application of radiofrequency energy. Efforts are made to minimize the number of electrode passes required for insertion; however, larger tumors may necessitate repositioning of the needle to achieve complete ablation. In such cases, the needle angle is adjusted and reinserted without fully withdrawing it, again utilizing CT guidance to ensure accuracy. Throughout the procedure, CT scanning is employed at short intervals to monitor for complications and to verify the position of the needle. Upon completion of the ablation, the needle is withdrawn without cauterizing the probe tract, thereby preserving the integrity of the surrounding tissue.