Gastroenterology Coding Alert

Photodynamic therapy offers several billable procedures - if you know what to look for In the coding universe, few treatments have the payment potential of photodynamic therapy (PDT). When your doctor performs PDT, reimbursement doors open for injection, endoscopy and light delivery services - three key components of the treatment.
 
That reimbursement potential comes with a price, says Carol Pohlig, BSN, RN, CPC, reimbursement analyst at the Hospital of the University of Pennsylvania in Philadelphia.
 
"The multiple codes involved in reporting PDT, as well as restrictive coverage guidelines, can make it difficult to code," she says. "Also, time increments lend to the intricacy of coding for this service."
 
In a nutshell, PDT is a two-step treatment used to treat esophageal cancer and lung cancer (it is also gaining acceptance as a viable treatment for Barrett's esophagus). In the first step of PDT, the gastroenterologist intravenously administers porfimer sodium - generic name Photofrin. This photosensitizing drug works its way through the patient's system and selectively accumulates in cancerous and precancerous areas.
 
Two days later, the Photofrin is activated by exposing the tissue to light from an endoscope. When the light hits the photosensitized area, a reaction occurs that destroys the targeted tissue. PDT is used as the sole treatment modality on some patients and in conjunction with chemotherapy or radiation therapy on others.
 
Here are some common codes that most carriers will accept as medically necessary conditions for the use of code J9600 (Porfimer sodium, 75 mg):
  150.x series - Malignant neoplasm of esophagus
  162.x series - 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. PDT is an arduous procedure for a patient, and it can be a frustrating challenge for coders. Mary Garner, CPC, CCP, of Gastrointestinal Associates PC in Knoxville, Tenn., says much of the difficulty lies in the length of the procedure and all the variables present in each individual claim.
 
"[Gastroenterologists] use light application to ablate normal tissue, used in conjunction with an esophagoscopy along with the photodynamic therapy," says Garner, whose practice sees patients from all around the United States for PDT sessions. On top of all that, "You have to consider how much time is taken [to perform the procedure]."
 
Here is a closer look at PDT coding guidelines. Report Photofrin Administration and Supply You can report Photofrin injections when the physician gives the shot or when a nurse injects with the physician's supervision. Codes will vary from situation to situation, Pohlig says.
 
"The administration code is selected depending on whether it was infused or injected, on an inpatient or outpatient, [...]