How To Use CPT Code 20982

CPT 20982 refers to ablation therapy for the reduction or eradication of one or more bone tumors, such as metastasis, including adjacent soft tissue when involved by tumor extension. This procedure is performed percutaneously, meaning through the skin, and may include imaging guidance when necessary. The technique primarily utilizes radiofrequency energy to destroy the tumor and any surrounding affected tissue.

1. What is CPT code 20982?

CPT code 20982 represents a specialized medical procedure known as radiofrequency ablation (RFA) aimed at treating bone tumors, particularly metastatic lesions. This procedure is crucial in oncology, as it provides a minimally invasive option for patients suffering from bone tumors that may have spread from other parts of the body. The primary goal of this procedure is to reduce or completely eradicate the tumor while also addressing any adjacent soft tissue that may be affected by tumor extension. By utilizing radiofrequency energy, the provider can effectively target and destroy the tumor cells, offering patients a potential relief from pain and other symptoms associated with bone tumors.

2. Qualifying Circumstances

This CPT code can be utilized in specific clinical scenarios where a patient presents with one or more bone tumors that require intervention. The procedure is appropriate when the tumors are accessible for percutaneous treatment and when imaging guidance is available to ensure accurate targeting of the tumor site. Limitations may include the size and location of the tumor, as well as the patient’s overall health status. It is inappropriate to use this code for benign tumors or in cases where the tumor is not amenable to percutaneous intervention. Additionally, if the tumor has extensive involvement with critical structures that cannot be safely treated with RFA, this code should not be applied.

3. When To Use CPT 20982

CPT code 20982 is used when a provider performs radiofrequency ablation on bone tumors, specifically in cases where the tumors are metastatic and involve adjacent soft tissue. The procedure is typically indicated when other treatment options, such as surgery or systemic therapies, are not viable or have failed. It is important to note that this code should not be used in conjunction with codes for more invasive surgical procedures targeting the same tumor, as it represents a distinct and less invasive approach. Providers must ensure that the use of this code aligns with the patient’s treatment plan and clinical indications for RFA.

4. Official Description of CPT 20982

Official Descriptor: Ablation therapy for reduction or eradication of 1 or more bone tumors (eg, metastasis) including adjacent soft tissue when involved by tumor extension, percutaneous, including imaging guidance when performed; radiofrequency.

5. Clinical Application

The clinical context for CPT code 20982 is centered around the treatment of metastatic bone tumors, which can cause significant morbidity and impact the quality of life for patients. The procedure is designed to alleviate pain, reduce tumor burden, and potentially improve overall function. By employing radiofrequency ablation, healthcare providers can offer a targeted approach that minimizes damage to surrounding healthy tissue while effectively addressing the tumor. This method is particularly beneficial for patients who may not be candidates for more invasive surgical options due to health concerns or the complexity of the tumor’s location.

5.1 Provider Responsibilities

During the procedure, the provider has several key responsibilities. Initially, the patient is appropriately prepped and anesthetized to ensure comfort. The provider then makes a small percutaneous incision through the skin and introduces a radiofrequency ablation electrode needle into the tumor site. Utilizing imaging guidance, the provider carefully advances the electrode needle to the precise location of the tumor. Once the needle’s position is confirmed, an electrical current is applied through the electrode, generating heat that destroys the tumor and any affected surrounding soft tissue. After the ablation is complete, the provider withdraws the needle and closes the incision, ensuring proper care and monitoring throughout the process.

5.2 Unique Challenges

One of the unique challenges associated with this procedure is the need for precise targeting of the tumor, especially when adjacent structures are involved. The use of imaging guidance is critical to navigate the anatomy safely and effectively. Additionally, the provider must consider the size and complexity of the tumor, as larger or more irregularly shaped tumors may require longer ablation times or multiple treatment sessions. There is also the potential for complications, such as damage to surrounding tissues or inadequate tumor destruction, which necessitates careful planning and execution of the procedure.

5.3 Pre-Procedure Preparations

Before performing the procedure, the provider must conduct thorough evaluations, including imaging studies to assess the tumor’s size, location, and involvement with surrounding tissues. A comprehensive review of the patient’s medical history and current health status is essential to determine the appropriateness of radiofrequency ablation. Additionally, the provider must ensure that the necessary imaging equipment and radiofrequency ablation devices are available and functioning properly to facilitate a successful procedure.

5.4 Post-Procedure Considerations

After the procedure, the patient requires careful monitoring to assess for any immediate complications, such as bleeding or infection at the incision site. Follow-up imaging may be necessary to evaluate the effectiveness of the ablation and to ensure that the tumor has been adequately treated. The provider should also discuss post-procedure care instructions with the patient, including pain management strategies and any activity restrictions to promote healing and recovery.

6. Relevant Terminology

Ablation: The removal or destruction of a body part or organ, or the elimination of its function, often used in the context of treating tumors.

Electrode: A device that can transmit and receive electrical impulses, used in various medical procedures, including radiofrequency ablation.

Image guided, imaging guidance: The use of imaging techniques such as fluoroscopy or ultrasound during surgical procedures to enhance accuracy and safety.

Radiofrequency ablation (RFA): A minimally invasive procedure that uses heat generated by focused electromagnetic waves to destroy abnormal or diseased tissue.

Metastasis: The process by which cancer cells spread from the original site to other parts of the body, often leading to secondary tumors.

Percutaneous: Referring to procedures performed through the skin, typically involving small incisions for the insertion of instruments.

Tumor: An abnormal growth of tissue or mass, which can be benign (non-cancerous) or malignant (cancerous).

7. Clinical Examples

1. A patient diagnosed with metastatic breast cancer presents with bone lesions in the spine. The provider recommends radiofrequency ablation to alleviate pain and reduce tumor burden.

2. A patient with prostate cancer experiences bone metastasis in the pelvis. The provider uses imaging guidance to perform RFA on the affected areas, targeting both the tumor and surrounding soft tissue.

3. A patient with lung cancer has developed multiple bone tumors in the ribs. The provider opts for percutaneous radiofrequency ablation to treat these lesions effectively.

4. A patient suffering from severe pain due to metastatic renal cell carcinoma in the femur undergoes RFA to destroy the tumor and relieve discomfort.

5. A patient with a history of melanoma presents with a solitary bone metastasis in the shoulder. The provider performs radiofrequency ablation to target the tumor while preserving surrounding healthy tissue.

6. A patient with multiple myeloma has localized bone lesions that are causing significant pain. The provider utilizes RFA to treat these lesions percutaneously.

7. A patient diagnosed with thyroid cancer has developed bone metastases in the vertebrae. The provider employs imaging guidance to perform radiofrequency ablation on the affected areas.

8. A patient with a history of colorectal cancer presents with bone metastasis in the pelvis. The provider recommends RFA to manage the tumor and improve the patient’s quality of life.

9. A patient with a metastatic tumor in the humerus experiences pain and limited mobility. The provider performs percutaneous radiofrequency ablation to address the tumor and restore function.

10. A patient with metastatic ovarian cancer has developed bone lesions in the spine. The provider uses imaging guidance to accurately perform RFA on the affected areas, aiming to alleviate pain and improve overall well-being.