Gastroenterology Coding Alert

Test your knowledge on these PDT-related scenarios

Think you know PDT? Take this quiz on the different stages of photodynamic therapy and prove it. If you get stuck, refer back to "Know the Components of PDT for Dynamic Reimbursement Potential" on page 9.

Scenario 1: A patient undergoes two hours of photodynamic therapy. Which code(s) should you report for this treatment?
 
Answer: Report +96570 (Photodynamic therapy by endoscopic application of light to ablate abnormal tissue via activation of photosensitive drug[s]; first 30 minutes [list separately in addition to code for endoscopy or bronchoscopy procedures of lung and esophagus]) for the first 30 minutes of illumination, followed by +96571 (...; each additional 15 minutes [list separately in addition to code for endoscopy or bronchoscopy procedures of lung and esophagus]) x 6 for the remaining 90 minutes.

Scenario 2: During a photodynamic therapy session, your gastroenterologist delivers light to the patient's esophagus to activate the tissue-destroying agent in Photofrin. Can you bill for the endoscopy? If so, which code(s) should you report?
 
Answer: Yes, you can bill for the endoscopy - just be careful which code you report. Since the endoscope was used only in the esophagus, report 43228 (Esophagoscopy, rigid or flexible; with ablation of tumor[s], polyp[s], or other lesion[s], not amenable to removal by hot biopsy forceps, bipolar cautery or snare technique).

Scenario 3: Your gastroenterologist injects Photofrin in an outpatient setting using the push technique. Which  code should you report for the injection? Can you bill for the supply of Photofrin in this situation? If so, what is the proper code?
 
Answer: For a Photofrin injection using the push technique, report 96408 (Chemotherapy administration, intravenous; push technique).
 
Since the session was conducted in an outpatient setting, you can get paid for the supply of Photofrin by reporting J9600 (Porfimer sodium, 75 mg).