Bill all three or get a denial: supply, injection, and illumination.
Coding for photodynamic therapy (PDT) involves three key components, which means you should look into multiple CPT® codes to describe your claim appropriately. But this could jeopardize your claims for these procedures if you’re not careful of PDT’s time increments and restrictive coverage guidelines.
Check out these tips so as not to lose your way into the complexity of PDT multiple coding.
A. Claim Drug Supply with J9600
Usually, gastroenterologists use PDT as a palliative treatment for esophageal cancer patients who experience difficulty in swallowing caused by the tumor. Physicians also perform PDT as non-surgical treatment for Barrett’s Esophagus with high grade dysplasia complications (although still considered experimental by most carriers).
What goes on during PDT: Patients receive an injection of photoactive drug (porfimer sodium), which is absorbed in the tissues, including cancerous or precancerous cells. While this drug disappears from most healthy tissue, it remains in cancer cells and certain other organs. This way, the physician can later target cancerous cells and destroy them with a laser light delivered by a fiber optic endoscope. Patients get sedation during this procedure.
You would report the drug supply with J9600 (Injection, porfimer sodium, 75 mg) only when your gastroenterologist performs PDT in an office/outpatient setting. Make sure you support J9600 with a diagnosis that your carrier accepts as medically necessary. These conditions may include:
- 150.x — Malignant neoplasm of esophagus;
- 162.x — Malignant neoplasm of trachea, bronchus, and lung;
- 197.0 — Secondary malignant neoplasm of lung;
- 197.8 — Secondary malignant neoplasm of other digestive organs and spleen;
- 230.1 — Carcinoma in situ of esophagus;
- 231.2 — Carcinoma in situ of bronchus and lung.
…
