Capture all facets of therapy to maximize reimbursements.
While your pulmonologist makes use of photodynamic therapy (PDT) to treat a patient with cancer, you are required to report all important components of the therapy that involves infusion, bronchoscopy along with the laser activation. Read on for some refresher tips to confront photodynamic therapy reporting with confidence and ascertain your CPT codes and ICD-9 codes.
Capture All Aspects of the Infusion
The first step to photodynamic therapy is the intravenous infusion of Photofrin (Porfimer), which could be carried out by your pulmonologist or by a nurse under the supervision of your pulmonologist. In case it is carried out in the hospital, no charge can be made. In case it is carried out in the office, a charge can be made although carried out by a nurse since she will be supervised by the pulmonologist.
The infusion of Photofrin must take about 10-15 minutes. In case the infusion lasts less than 30 minutes, you must use CPT code 96374 (Therapeutic, prophylactic, or diagnostic injection [specify substance or drug]; intravenous push, single or initial substance/drug). In case the infusion lasts over 30 minutes, you must use CPT code 96365 (Intravenous infusion, for therapy, prophylaxis, or diagnosis (specify substance or drug); initial, up to 1 hour)."
Besides the infusion, you will be required to report the J code for Photofrin. You will then report this with J9600 (Injection, porfimer sodium, 75 mg).
Note Timelines for Next Procedure
Prior to the infusion of Photofrin, the patient comes back to your pulmonologist's office after a period of 48 hours. This time gap is offered to facilitate selective absorption of the Photofrin by the cancerous cells for the reason that your pulmonologist can clearly detect it to destroy it. Your pulmonologist will then undertake a bronchoscopy to detect the areas that need to be treated with the laser in order to destroy the cancerous cells. As this procedure is carried out to destroy the tumor using laser therapy, you have to report the procedure with CPT code 31641 (Bronchoscopy, rigid or flexible, including fluoroscopic guidance, when performed; with destruction of tumor or relief of stenosis by any method other than excision [e.g., laser therapy, cryotherapy]).
Example: Use this scenario to guide your coding:
A 66 year old patient with bronchogenic carcinoma experiences photodynamic therapy through bronchoscopy 48 hours prior to receiving a 15 minute IV infusion of Photofrin. The photodynamic therapy continues for 55 minutes. The photodynamic therapy should be coded with CPT 96570 , 96571x2 in addition to 31641. The ICD-9 code would be 162.9 for bronchogenic carcinoma. The infusion of Photofrin would be coded 96374 on the earlier day of the infusion along with 162.9.
Note: In case your pulmonologist carries out the laser activation for less than 23 minutes after initiation, then you are required to append modifier 52 (Reduced services) to CPT code 96570.
While your pulmonologist makes use of photodynamic therapy (PDT) to treat a patient with cancer, you are required to report all important components of the therapy that involves infusion, bronchoscopy along with the laser activation. Read on for some refresher tips to confront photodynamic therapy reporting with confidence and ascertain your CPT codes and ICD-9 codes.
Capture All Aspects of the Infusion
The first step to photodynamic therapy is the intravenous infusion of Photofrin (Porfimer), which could be carried out by your pulmonologist or by a nurse under the supervision of your pulmonologist. In case it is carried out in the hospital, no charge can be made. In case it is carried out in the office, a charge can be made although carried out by a nurse since she will be supervised by the pulmonologist.
The infusion of Photofrin must take about 10-15 minutes. In case the infusion lasts less than 30 minutes, you must use CPT code 96374 (Therapeutic, prophylactic, or diagnostic injection [specify substance or drug]; intravenous push, single or initial substance/drug). In case the infusion lasts over 30 minutes, you must use CPT code 96365 (Intravenous infusion, for therapy, prophylaxis, or diagnosis (specify substance or drug); initial, up to 1 hour)."
Besides the infusion, you will be required to report the J code for Photofrin. You will then report this with J9600 (Injection, porfimer sodium, 75 mg).
Note Timelines for Next Procedure
Prior to the infusion of Photofrin, the patient comes back to your pulmonologist's office after a period of 48 hours. This time gap is offered to facilitate selective absorption of the Photofrin by the cancerous cells for the reason that your pulmonologist can clearly detect it to destroy it. Your pulmonologist will then undertake a bronchoscopy to detect the areas that need to be treated with the laser in order to destroy the cancerous cells. As this procedure is carried out to destroy the tumor using laser therapy, you have to report the procedure with CPT code 31641 (Bronchoscopy, rigid or flexible, including fluoroscopic guidance, when performed; with destruction of tumor or relief of stenosis by any method other than excision [e.g., laser therapy, cryotherapy]).
Example: Use this scenario to guide your coding:
A 66 year old patient with bronchogenic carcinoma experiences photodynamic therapy through bronchoscopy 48 hours prior to receiving a 15 minute IV infusion of Photofrin. The photodynamic therapy continues for 55 minutes. The photodynamic therapy should be coded with CPT 96570 , 96571x2 in addition to 31641. The ICD-9 code would be 162.9 for bronchogenic carcinoma. The infusion of Photofrin would be coded 96374 on the earlier day of the infusion along with 162.9.
Note: In case your pulmonologist carries out the laser activation for less than 23 minutes after initiation, then you are required to append modifier 52 (Reduced services) to CPT code 96570.
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