Pulmonology Coding Alert

Coding Quiz:

2 Scenarios Test Your Grasp of Photodynamic Therapy Codes

Published on Mon Jun 21, 2004

Think you know how to report photodynamic therapy (PDT)? Coding experts have helped us pull together these two scenarios on the different stages of PDT to help you prove it.

Scenario 1: A patient undergoes two hours of PDT. Which code(s) should you report for this treatment? Answer: Report +96570 (Photodynamic therapy by endoscopic application of light to ablate abnormal tissue via activation of photosensitive drug[s]; first 30 minutes 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 esophagus]) for the first 30 minutes of illumination, followed by +96571 (... each additional 15 minutes [list separately in addition to code for endoscopy or bronchoscopy procedures of lung and esophagus]) x 6 for the remaining 90 minutes.

You must also report 31641 (Bronchoscopy [rigid or flexible]; with destruction of tumor or relief of stenosis by any method other than excision [e.g., laser therapy, cryotherapy]) because 96570 and 96571 are add-on codes that must be reported with a primary procedure. Tip: Because a pulmonologist cannot perform PDT without bronchoscopy, always make sure your reporting reflects this. Scenario 2: During a PDT session, your pulmonologist delivers light to the lung-cancer patient's lungs to activate the tissue-destroying agent in Photofrin. Can you bill for the bronchoscopy? If so, which code(s) should you report?

Answer: In patients with lung cancer, the light is provided through the bronchoscopy tube. You should report this with the appropriate bronchoscopic code (31641, Bronchoscopy; with destruction of tumor or relief of stenosis ...) and the appropriate PDT codes (96570 and 96571). The codes for PDT are add-on codes, and you can only report them with a primary procedure code, such as the bronchoscopy code 31641. You report code 96570 for the first 30 minutes of PDT, and 96571 for each additional 15 minutes.

Remember: You can't report code 96571 without code 96570.

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