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Gastroenterology Coding Alert

8 Ways to Make PDT Coding More Rewarding

Published on Fri Jan 02, 2004

Check your claim against this list for maximum PDT payment

Are you sure your photodynamic therapy claim is complete? Ask yourself these questions before sending out the claim and reduce the risk of partial payment or denial:
 

  •  Have I billed for a pre-PDT endoscopy, if one was performed?
     
  •  Have I reported the Photofrin administration, if the physician gave the injection or oversaw it?
     
  •  Have I provided a diagnosis code, if there is one, to justify the Photofrin administration?
     
  •  Have I reported the proper Photofrin administration code (based on the method of Photofrin delivery, where it was conducted and whether a doctor was present)?
     
  •  Have I billed for the supply of Photofrin, if the administration occurred in an office/outpatient setting?
     
  •  Have I reported an endoscopy, if the gastroenterologist performed one to send light to the tissue-destroying agent in Photofrin?
     
  •  Have I reported the time taken for the PDT session down to the quarter-hour, using 96570 and 96571?
     
  •  Have I billed for the patient's follow-up visit after the photodynamic therapy administration?
     If you answered "yes" to all of the above questions relevant to your specific claim, then your PDT claim is ready for the mail.

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