Percutaneous ablation of organs

Procedure coding

In European countries, the situation with procedure coding for percutaneous ablation of organ lesions differs depending on the anatomical site of intervention: procedure coding for percutaneous ablation of liver, lung, and kidney tissue is well established in most countries, whereas for other anatomical sites, the availability of specific coding is limited. For example, in the Netherlands, there is specific procedure code 036089 “Percutaneous excision or coagulation disorder kidney” and 035240 “Radiofrequency ablation of pathological liver tissue”. For other anatomical sites nospecific procedure code for RF ablation of diseased tissue by a radiologist (code 080058) can be used.

In many countries, the type of energy used is specified in the procedure code description. The typical ones include radiofrequency and cryoablation. Other types of energy are either not specifically coded or can be described using supplementary codes. For example, percutaneous ablation of lesions using microwaves is specified in the procedure code descriptions in Germany. In contrast, supplementary codes are used for it in England and countries of the Nordic region.

Policy considerations

Percutaneous ablation of organ lesions can be subject to specific policies from payers or national decision-makers in the countries where such frameworks exist. 

For example, in 2017, the Dutch Healthcare Institute (ZIN) published a Position on thermal ablation in colorectal liver metastases, which concluded that the procedure could be reimbursed under basic health insurance only in unresectable colorectal liver metastases in case of radical surgery for colorectal cancer.

Future challenges 

Percutaneous radiofrequency and cryoablation of liver, lung, and kidney lesions have established reimbursement and funding in most European countries. New health technology assessments are unlikely to be relevant. Procedures for ablation of other organs, devices for percutaneous ablation of organ lesions with unique designs, or alternative energy sources might require the development of procedure codes, establishing reimbursement, funding, and obtaining HTA recommendations.