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Pulmonology Coding Alert

Reader Question:

Know How to Code Photodynamic Therapy

Published on Fri Aug 01, 2003

Question: How should I bill for photodynamic therapy?

California Subscriber

Answer: Photodynamic therapy (PDT) involves the infusion of a light-activated drug. The activation of this drug results in a photochemical reaction, which treats the diseased tissue without affecting the surrounding tissue. Porfimer sodium (Photofrin) is a light-activated drug commonly used for treating patients with micro-invasive endobronchial non-small cell lung cancer. PDT, along with Photofrin, is a two-stage process requiring the administration of 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. Report drug infusion (90784), and the J code (drug code) for Porfimer (J9600). CMS considers 90784 bundled into any other service payable under the Physician Fee Schedule when reported on the same date. For this reason, some insurers may prefer that you report the therapeutic or diagnostic infusion codes (90780-90781). Check with your carrier to ensure appropriate reporting.
     
  •  The second stage is illumination with laser light 40-50 hours after injection of the medication. In patients with lung cancer, the laser light is provided through the bronchoscopy tube, which you should report as 31641 (Bronchoscopy; with destruction of tumor or relief of stenosis ...). Also, report 96570 for the first 30 minutes of PDT, and 96571 for each additional 15 minutes. Code 96571 cannot be reported without 96570.

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