# Light Box



## Danielle (Mar 13, 2012)

We are having our patients apply Vaseline prior to the light box treatment and billing out the CPT code 96910;photochemotherapy, tar and ultraviolet B or petrolatum and ultraviolet B. If instead of using Vaseline and we started using Mineral Oil, can we still bill CPT 96910?


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## hkatie (Mar 16, 2012)

Danielle,

Both are petroleum derivitives. From a treatment point of view, mineral oil works better, cleans up faster, and is useful when the tech needs to do light debridements before tx. That's the long answer phototherapist answer. Short answer from coding point of view is "yes," but make sure your techs document its use on each tx.


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## gracigoo (Jun 24, 2014)

*96910*

what if the pt only uses sunscreen to the area's they don't want to get the UV-B rays? then what cpt code should you use?


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## CatchTheWind (Jun 25, 2014)

96900


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## gracigoo (Aug 28, 2014)

in order to bill the 96910 can the patient apply (we use Vanicream) themselves or does the nurse have to do it?


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## CatchTheWind (Aug 28, 2014)

My understanding is that the office staff has to apply it, but I've been getting pushback from our clinical staff about this.  They do NOT want to be rubbing oil on people's bodies!  So I'm glad you asked, because I also would like some definitive clarification.


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## gracigoo (Sep 3, 2014)

yes thats exactly how i am understanding it as well, the staff have to do it. mine aren't too keen on the idea though either. im hoping someone can clarify as well for us.


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## hkatie (Sep 9, 2014)

Here's what AAD had to say back in 2009 in the Coding Consult newsletter: (my emphasis in bold)

"Insurers Review Billing for Photochemotherapy (CPT 96910)

Recent private insurer and Medicare audit findings on claims for
CPT code 96910 Photochemotherapy tar and ultraviolet B (Goeckerman
treatment) or petrolatum and ultraviolet B indicate that the
procedure was not being documented or billed appropriately. As
currently defined in AMA CPT, this procedure specifically includes
the use of Tar or petrolatum with the light therapy.
The American Medical Association?s (AMA) Current Procedure
Terminology (CPT) coder?s Desk Reference defines CPT 96910
as ?the *physician* uses photosensitive chemicals and light rays
to treat skin ailments?. The photosensitive chemicals are
further defined as either tar or petrolatum. A review of the
Practice Expense Data used by the Center for Medicare and
Medicaid Services (CMS) to set the Practice Expense RVUs
*includes clinical staff time and includes the cost of medical
supplies needed to provide this service.*
AAD Coding & Reimbursement staff are receiving a growing
number of reports from dermatology practices that private
insurers as well as Medicare are reviewing photochemotherapy
treatment documentation. Carriers are reducing the
procedure to 96900 if the documentation in the medical
record or flow sheet does not include the documentation of
application of tar, petrolatum or other emollient. They are
especially noting if the application of an emollient had been
documented and if not, what was the medical necessity of
non-application."

Our photo clinic uses A LOT of supplies per patient: gloves, gauze, oil, drapes, wipes... The list goes on, but we're getting paid for all those supplies in the cost of reimbursement. 

It can be hard if the practice's culture has not been to assist the patient with oil application, but in the long run, it makes for better results. In my experience, techs apply oil better than patients do. It's also a great opportunity to evaluate the patient's response to the last light treatment and catch problems that need a supervising MD's judgment. Not insignificantly, some of my patients only ever experienced human touch when I would apply lotion or oil to their backs. (And yes, sometimes butts too. It's covered in skin that often needs medical attention. You wear gloves, apply with gauze and move on, no big deal.) 

I'd start with the ordering and supervising physicians. Show them what the Academy states, but don't just focus on compliance. It's also great patient care. Good luck!

Katie


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## gracigoo (Sep 12, 2014)

AWESOME!!! thanks Katie


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## CatchTheWind (Sep 19, 2014)

The AAD's coding expert just gave me another interesting piece of information that supports the stance that the MA must apply the oil in order to bill 96910:  She pointed out that the AMA's "RBRVS Data Manager," identifies the ancillary staff's time spent on 96900 as 21 minutes, while the ancillary staff's time for 92910 is 43 minutes. This means that they expect, on average, that the MA or nurse is spending more than twice the time with the patient on a 96910 as on a 96900. The only explanation for this additional time is application of the oil.


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## gracigoo (Sep 24, 2014)

im having a bit of an issue, now that our supervisors and myself told the nursing staff that they need to apply the photosensitizing agent to the pt. in order to bill this 96910 code. well they do not want to do this (apply it to the pt because they say they are uncomfortable), so instead they are letting the patient apply it, still documenting that the pt applied it themselves but coding it as the 96900...
our fee increased dramatically this year on the 96910 also so they don't want the pt to have too high of a deductible either, so thats another reason why they want to charge the 96900...i don't feel comfortable putting through these charges. wouldn't this be fraudulent billing?


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## CatchTheWind (May 23, 2016)

One of our doctors asked to revisit this question, and he feels strongly that there is nothing that states that the application must be done by our staff rather than by the patient.  

I do see his point: The CPT code description for 96910 only says "Photochemotherapy; tar and ultraviolet B... or petrolatum and ultraviolet B" (with no reference to how the tar or petrolatum gets applied).  

Even where the Coder's Desk Reference says "the physician uses photosensitive chemicals and light rays," that doesn't necessarily mean that the MA has to apply the chemicals, just that they have to be "used."  

The physician also pointed out that you cannot assume that the reason for the the difference in time spent by the MA is because she is applying the oil. Maybe she is spending this extra time supervising the patient's application of the oil, or wiping it off afterwards even though she didn't put it on. Or maybe there is some other difference between regular UV therapy and "photohemotherapy."

So it really does seem, in retrospect, that there is no clear requirement for the staff to apply the oil, as long as oil is being used.


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## lblakeley (May 23, 2022)

gracigoo said:


> in order to bill the 96910 can the patient apply (we use Vanicream) themselves or does the nurse have to do it?


If the patient is applying do not bill CPT code 96910.  The OIG just hit a dermatology practice for this.  If the patient applies it use CPT code 96900.


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