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Gastroenterology Coding Alert

You Be the Coder:

Watch Out For External , Endoscopic PDT Disparity

Published on Mon Oct 10, 2011

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 SubscriberAnswer: 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, [...]
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