Gastroenterology Coding Alert

Question: My op notes indicate the gastroenterologist performed 75 minutes of photodynamic therapy (PDT) and used an endoscope to deliver light, but I-m unsure how to code the light application properly. What is the correct code combination for this visit?

Florida Subscriber

Answer: To best code this claim, break it down into two parts: the endoscope procedure and the PDT.

Endoscope procedure: When your gastroenterologist uses the endoscope to deliver light that activates the tissue-destroying agent in Photofrin, you may be able to report an endoscopy. Gastroenterology offices commonly choose one of the following codes to report endoscope use during PDT:

- 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

- 43258 -- Upper gastrointestinal endoscopy including esophagus, stomach, and either the duodenum and/or jejunum as appropriate; with ablation of tumor(s), polyp(s), or other lesion(s) not amenable to removal by hot biopsy forceps, bipolar cautery or snare technique.

PDT: Since the start of this decade, the CPT manual has included codes to represent the light used during PDT. On your claim, you should:

- report +96570 (Photodynamic therapy by endoscopic application of light to ablate abnormal tissue via activation of photosensitive drug[s]; first 30 minutes [listseparately in addition to code for endoscopy or bronchoscopy procedures of lung and esophagus]) for the first 30 minutes of illumination.

- report +96571 x 3 (... each additional 15 minutes [list separately in addition to code for endoscopy or bronchoscopy procedures of lung and esophagus]) to account for the remaining 45 minutes of illumination.

These are add-on codes, and you-ll attach them to the endoscopy code -- so you do not need to provide any modifiers on the claim.