Gastroenterology Coding Alert

Find out why you won't need any modifiers for your light delivery codes When your gastroenterologist uses photodynamic therapy (PDT), you've got three key components to code -- and three potential avenues of reimbursement. Our experts show you how to submit stellar claims every time.

- That reimbursement potential comes with a price, says Carol Pohlig, BSN, RN, CPC, senior coding and education specialist at the Hospital of the University of Pennsylvania in Philadelphia.

- "The multiple codes involved in reporting PDT, as well as restrictive coverage guidelines, can make it difficult to code," she says. "Also, time increments lend to the intricacy of coding for this service."
Get Acquainted With PDT -
What it is: PDT is a two-step treatment used to treat esophageal cancer and lung cancer (it is also gaining acceptance as a viable treatment for Barrett's esophagus). In the first PDT step, the gastroenterologist intravenously administers porfimer sodium (brand name Photofrin). This photosensitizing drug works its way through the patient's system and selectively accumulates in cancerous and precancerous areas.
- Two days later, the physician activates the Photofrin by exposing the tissue to light from an endoscope. When the light hits the photosensitized area, a reaction occurs that destroys the targeted tissue. Physicians use PDT as the sole treatment modality for some patients and with chemotherapy or radiation therapy for others.
- Common supporting diagnoses: Here are some common codes that most carriers will accept as medically necessary conditions for using J9600 (Porfimer sodium, 75 mg): • 150.x -- Malignant neoplasm of esophagus • 162.x -- Malignant neoplasm of trachea, bronchus, and lung • 197.0 -- Secondary malignant neoplasm of lung • 197.8 -- Secondary malignant neoplasm of other digestive organs and spleen • 230.1 -- Carcinoma in situ of esophagus • 231.2 -- Carcinoma in situ of bronchus and lung. PDT is an arduous procedure for a patient, and reporting it can be a frustrating challenge for coders. The difficulty lies in the procedure's length and all the variables present in each claim. "Time is a critical factor in coding, and physicians often poorly document time," says Michael Weinstein, MD, a gastroenterologist in Washington, D.C., and former member of the AMA's CPT Advisory Panel. "Additionally, the use of PDT for Barrett's mucosa is still considered experimental by most carriers. Appeals are often needed explaining the reason for PDT." - Here is a closer look at PDT coding guidelines. Report Photofrin Administration and Supply You can report Photofrin injections when the physician performs the administration or when provided by a nurse with the physician's supervision. Codes will vary from situation to situation, Pohlig says. "You'll select the administration code depending on the length of the infusion, on [...]