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Laparoscopy, surgical ablation of one or more liver tumors using cryosurgical techniques involves a minimally invasive surgical procedure aimed at treating liver tumors. The procedure begins with the creation of a small incision near the umbilicus, through which a trocar is inserted to establish pneumoperitoneum, allowing for the inflation of the abdominal cavity. This inflation is crucial as it provides the surgeon with a better view and access to the internal organs. Additional incisions are made in the upper and lower quadrants of the abdomen to insert more trocars, facilitating the use of various surgical instruments. During the procedure, the abdominal cavity is thoroughly inspected for any extrahepatic tumors or abnormalities, and any adhesions present are carefully lysed using both blunt and sharp dissection techniques. The liver is then mobilized, and all eight hepatic segments are inspected to locate the tumors. In the context of cryosurgical ablation, ultrasound guidance is employed to accurately position one or more cryoprobes into the tumor. The procedure involves initiating a freeze cycle, which creates an ice ball around the tumor, effectively destroying the tumor cells. Following the freeze cycle, the tissue is thawed, and the site is monitored to ensure complete destruction of the tumor along with a margin of healthy tissue. Multiple freeze-thaw cycles may be necessary to achieve complete tumor necrosis. This meticulous approach is repeated for each tumor present until all tumors have been successfully ablated. Upon completion of the procedure, the gas is released from the abdomen, and the laparoscope along with the surgical instruments is removed, followed by the closure of the portal incisions.
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The procedure is indicated for the treatment of liver tumors, specifically when surgical intervention is necessary to ablate one or more tumors present in the liver. The following conditions may warrant the use of this procedure:
The procedure involves several key steps to ensure effective ablation of liver tumors:
After the completion of the cryosurgical ablation procedure, patients are typically monitored for any immediate complications. Post-procedure care may include pain management and observation for signs of infection or bleeding. Patients may be advised on activity restrictions and follow-up appointments to assess recovery and monitor for any recurrence of tumors. The expected recovery time can vary based on individual patient factors and the extent of the procedure performed. It is essential for healthcare providers to provide clear instructions regarding post-operative care to ensure optimal recovery and outcomes.
| Short Descr | LAPARO ABLATE LIVER CRYOSURG | Medium Descr | LAPS SURG ABLTJ 1 > LVR TUM CRYOSURG | Long Descr | Laparoscopy, surgical, ablation of 1 or more liver tumor(s); cryosurgical | Status Code | Active Code | Global Days | 090 - Major Surgery | PC/TC Indicator (26, TC) | 0 - Physician Service Code | Multiple Procedures (51) | 2 - Standard payment adjustment rules for multiple procedures apply. | Bilateral Surgery (50) | 0 - 150% payment adjustment for bilateral procedures does NOT apply. | Physician Supervisions | 09 - Concept does not apply. | Assistant Surgeon (80, 82) | 2 - Payment restriction for assistants at surgery does not apply to this procedure... | Co-Surgeons (62) | 1 - Co-surgeons could be paid, though supporting documentation is required... | Team Surgery (66) | 0 - Team surgeons not permitted for this procedure. | Diagnostic Imaging Family | 99 - Concept Does Not Apply | APC Status Indicator | Hospital Part B services paid through a comprehensive APC | Type of Service (TOS) | 2 - Surgery | Berenson-Eggers TOS (BETOS) | P5E - Ambulatory procedures - other | MUE | 1 | CCS Clinical Classification | 99 - Other OR gastrointestinal therapeutic procedures |
This is a primary code that can be used with these additional add-on codes.
| 49327 | Addon Code MPFS Status: Active Code APC N ASC N1 Laparoscopy, surgical; with placement of interstitial device(s) for radiation therapy guidance (eg, fiducial markers, dosimeter), intra-abdominal, intrapelvic, and/or retroperitoneum, including imaging guidance, if performed, single or multiple (List separately in addition to code for primary procedure) |
| 51 | Multiple procedures: when multiple procedures, other than e/m services, physical medicine and rehabilitation services or provision of supplies (eg, vaccines), are performed at the same session by the same individual, the primary procedure or service may be reported as listed. the additional procedure(s) or service(s) may be identified by appending modifier 51 to the additional procedure or service code(s). note: this modifier should not be appended to designated "add-on" codes (see appendix d). | 59 | Distinct procedural service: under certain circumstances, it may be necessary to indicate that a procedure or service was distinct or independent from other non-e/m services performed on the same day. modifier 59 is used to identify procedures/services, other than e/m services, that are not normally reported together, but are appropriate under the circumstances. documentation must support a different session, different procedure or surgery, different site or organ system, separate incision/excision, separate lesion, or separate injury (or area of injury in extensive injuries) not ordinarily encountered or performed on the same day by the same individual. however, when another already established modifier is appropriate it should be used rather than modifier 59. only if no more descriptive modifier is available, and the use of modifier 59 best explains the circumstances, should modifier 59 be used. note: modifier 59 should not be appended to an e/m service. to report a separate and distinct e/m service with a non-e/m service performed on the same date, see modifier 25. |
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| 2010-01-01 | Changed | Code description changed. |
| 2002-01-01 | Added | First appearance in code book in 2002. |
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