Here's what AAD had to say back in 2009 in the Coding Consult newsletter: (my emphasis in bold)
"Insurers Review Billing for Photochemotherapy (CPT 96910)
Recent private insurer and Medicare audit findings on claims for
CPT code 96910 Photochemotherapy tar and ultraviolet B (Goeckerman
treatment) or petrolatum and ultraviolet B indicate that the
procedure was not being documented or billed appropriately. As
currently defined in AMA CPT, this procedure specifically includes
the use of Tar or petrolatum with the light therapy.
The American Medical Association?s (AMA) Current Procedure
Terminology (CPT) coder?s Desk Reference defines CPT 96910
as ?the physician uses photosensitive chemicals and light rays
to treat skin ailments?. The photosensitive chemicals are
further defined as either tar or petrolatum. A review of the
Practice Expense Data used by the Center for Medicare and
Medicaid Services (CMS) to set the Practice Expense RVUs
includes clinical staff time and includes the cost of medical
supplies needed to provide this service.
AAD Coding & Reimbursement staff are receiving a growing
number of reports from dermatology practices that private
insurers as well as Medicare are reviewing photochemotherapy
treatment documentation. Carriers are reducing the
procedure to 96900 if the documentation in the medical
record or flow sheet does not include the documentation of
application of tar, petrolatum or other emollient. They are
especially noting if the application of an emollient had been
documented and if not, what was the medical necessity of
non-application."
Our photo clinic uses A LOT of supplies per patient: gloves, gauze, oil, drapes, wipes... The list goes on, but we're getting paid for all those supplies in the cost of reimbursement.
It can be hard if the practice's culture has not been to assist the patient with oil application, but in the long run, it makes for better results. In my experience, techs apply oil better than patients do. It's also a great opportunity to evaluate the patient's response to the last light treatment and catch problems that need a supervising MD's judgment. Not insignificantly, some of my patients only ever experienced human touch when I would apply lotion or oil to their backs. (And yes, sometimes butts too. It's covered in skin that often needs medical attention. You wear gloves, apply with gauze and move on, no big deal.)
I'd start with the ordering and supervising physicians. Show them what the Academy states, but don't just focus on compliance. It's also great patient care. Good luck!
Katie