Gastroenterology Coding Alert

Must: Prove D00.1's medical necessity when coding for PDT.

When a patient receives an injection of photoactive drug for photodynamic therapy (PDT), you would support the supply code (J9600) with a medically necessary diagnosis, for instance, 230.1 (Carcinoma in situ of esophagus). Esophageal cancer refers to the abnormal cell growths in the esophagus, which is the passageway from the throat to the stomach. Sometimes, physicians diagnose patients with precancerous lesions instead of invasive cancers. These lesions are called carcinoma in situ.

ICD difference: When ICD-9-CM shifts to ICD-10-CM in Oct. 1, 2013, code 230.1 will become D00.1 (Carcinoma in situ of esophagus). You will treat your claims for this diagnosis the same way as you do under ICD-9-CM.

Documentation: Don't forget to get validation from your gastroenterologist for the medical necessity of D00.1 when you link it to code J9600 in PDT. Some carriers cover the procedure for patients with completely obstructing esophageal cancer, partially obstructing esophageal cancer in patients who can't be satisfactorily treated with Nd:YAG laser therapy, and Barrett's esophagus carcinoma in situ.

Coder tips: You will have to turn to 230.1 in your ICD-10 manual. However, no significant change in treatment of these claims will happen. D00.1 will carry a one-to-one relationship with its ICD-9 counterpart 230.1.