Dermatology Coding Alert

Question: I hear that the 2004 fee schedule brought about some billing concerns related to reporting 96567 for photodynamic therapy. Would you please explain what we can expect when we bill for this procedure?

Virginia Subscriber

Answer: With photodynamic therapy (PDT), dermatologists use photochemical reactions for the treatment of malignant or benign diseases. PDT is a two-step procedure. In the first step, the dermatologist administers a photosensitizer to the patient by one of several routes (e.g., topical, oral, intravenous), and the cells all over the body absorb the photosensitizer.

The second step involves the activation of the photosensitizer. When the dermatologist exposes laser light to the treated cancer cells, the photosensitizing agent absorbs the light and produces an active form of oxygen that destroys the treated cancer cells.

With the new fee schedule, you can expect payment for both the procedure and the agent used during therapy. Use a HCPCS level II code for the agent in addition to an appropriate diagnosis.