Gastroenterology Coding Alert

Question: Our office recently began performing photodynamic therapy (PDT), and we were wondering the best way to code PDT-related pre- and postoperative services. For instance, a recent patient had a pre-PDT diagnostic endoscopy, then had a level-two evaluation and management service during a follow-up visit. Are either of these services bundled into an overall PDT care package?


Indiana Subscriber

 
Answer: In the situation you describe, you should be able to gain reimbursement for both services. The gastroenterologist often performs a pre-PDT endoscopy to pinpoint cancerous cells. When your gastroenterologist uses a pre-PDT endoscopy to zero in on the cancer, you should report 43200 (Esophagoscopy, rigid or flexible; diagnostic ...).

A few days after PDT ends, the gastroenterologist will see the patient to measure his post-PDT progress. The level of service for this visit can vary, but your office notes indicate a level-two service, so you should report 99212 (Office or other outpatient visit for the evaluation and management of an established patient, which requires at least two of these three key components: a problem-focused history; a problem-focused examination; straightforward medical decision making) for the follow-up.

Clinical and coding expertise for this issue provided by Michael Weinstein, MD, a gastroenterologist in Washington, D.C., and former member of the CPT advisory panel; and Linda Parks, MA, CPC, CCP, independent coding and billing consultant in Marietta, Ga.