Gastroenterology Coding Alert

Question: Our gastroenterologist performed photodynamic therapy (PDT) for one hour on a patient with Barrett's esophagus. We reported 96567 and were denied. What did we do wrong? Connecticut Subscriber Answer: Simply put, you used the wrong PDT code. As its explanation indicates, code 96567 (Photodynamic therapy by external application of light to destroy premalignant and/or malignant lesions of the skin and adjacent mucosa [e.g., lip] by activation of photosensitive drug[s], each phototherapy exposure session) is for external PDT, and the PDT the gastro performed was endoscopic, meaning you should not report an external PDT code. When a gastro administers PDT endoscopically, you should file a claim with a minimum of two codes: one for endoscopy and (at least) one for the illumination of the cancerous cells in the patient. If your gastroenterologist performs one hour of PDT on a patient, you should: • Report 43228 (Esophagoscopy, rigid or flexible; with [...]