Oncology & Hematology Coding Alert
Shed Light on Photodynamic Therapy Coverage
Question: Our oncologist recently started performing photodynamic therapy for esophageal cancer patients. How should we code for this service? If the oncologist performs an esophagoscopy with 45 minutes of PDT, report one unit each of 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), 96570, and 96571. The procedure involves the physician using a photosynthesizing agent (porfimer sodium or Photofrin) and subsequent exposure to a laser light source to cause tumor cell damage.
Florida Subscriber
Answer: CPT includes codes specific to endoscopic photodynamic therapy (PDT):
- +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 esophagus)
- +96571--... each additional 15 minutes (list separately in addition to code for endoscopy or bronchoscopy procedures of lung and esophagus).
If you supplied the drugs, you should also report them with the proper code, such as J9600 (Porfimer sodium, 75 mg).
Aetna covers the procedure for patients with completely obstructing esophageal cancer, partially obstructing esophageal cancer in patients who can't be satisfactorily treated with Nd:YAG laser therapy, and Barrett's esophagus carcinoma in situ and high-grade disease in patients who aren't candidates for esophagectomy. Certain lung cancer patients may also be covered (see www.aetna.com/cpb/data/CPBA0375.html).
You should only report the documented diagnosis, but be aware covered ICD-9 codes may include the following:
- 150.0-150.9--Malignant neoplasm of esophagus
- 230.1--Carcinoma in situ of digestive organs; esophagus
- 162.0-162.9--Malignant neoplasm of trachea, bronchus, and lung
- 530.85--Barrett's esophagus
- V10.03--Personal history of malignant neoplasm; esophagus
- V10.11--- bronchus and lung
- V10.12--- trachea.
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