Advanced Search

Pulmonology Coding Alert

Reader Question:

Follow the 2 Stages of Photodynamic Therapy

Published on Wed Apr 28, 2004

Question: How should I bill for photodynamic therapy?

California Subscriber

Answer: Photodynamic therapy (PDT) involves a light-activated drug infusion. This activation results in a photochemical reaction, which treats the diseased tissue without affecting the surrounding tissue.

Porfimer sodium (Photofrin) is a light-activated drug that physicians use to treat patients with micro-invasive endobronchial non-small cell lung cancer. PDT, along with Photofrin, is a two-stage process requiring the physician to administer the drug and light. Typically, pulmonologists only apply the light, but they may perform the Photofrin infusion as well.

Follow these steps for the appropriate reporting process for PDT:   

  •  The first stage is the intravenous injection of Photofrin. You may report the drug infusion (90784, Therapeutic, prophylactic or diagnostic injection [specify material injected]; intravenous) and the J code for Porfimer (J9600). CMS considers 90784 bundled into any other service payable under the Medicare Physician Fee Schedule when reported on the same date. 

  •  The second stage is illumination with laser light 40-50 hours after injection of the medication. In patients with lung cancer, the physician provides the laser light through the bronchoscopy tube, which you should report as 31641 (Bronchoscopy; with destruction of tumor or relief of stenosis ...). Also, list add-on code +96570 (Photodynamic therapy by endoscopic application of light to ablate abnormal tissue via activation of photosensitive drug[s] ...) for the first 30 minutes of PDT, and +96571 (... each additional 15 minutes ...) for each additional 15 minutes. You cannot report 96570 or 96571 alone, because they are add-on codes.

    • Other Articles in this issue of

    Pulmonology Coding Alert

    View All