Gastroenterology Coding Alert

Question: My colleague thinks we should report 96567 for an hour's photodynamic therapy (PDT) session on a patient with Barrett's esophagus. I don't think 96567 is the correct CPT. What advice can you give?

Texas Subscriber

Answer: You're right, 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 not the correct PDT code. Just as the descriptor indicates, this code is for external PDT, and the PDT the gastro performed was endoscopic, meaning you should not report an external PDT code.

Remember: 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 ablation of tumor[s], polyp[s], or other lesion[s], not amenable to removal by hot biopsy forceps, bipolar cautery or snare technique) for the endoscopy.
• Attach ICD-9 code 530.85 (Barrett's esophagus) to 43228.
• 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 gastrointestinal tract]) for the first half-hour of light application.
• Report +96571 x 2 (... each additional 15 minutes [List separately in addition to code for endoscopy or bronchoscopy procedures of lung and gastrointestinal tract]) for the second half-hour of light application.