Pulmonology Coding Alert

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 drug and light. Typically, pulmonologists only apply the light. However, there may be instances when the pulmonologist performs the Photofrin infusion as well.
 
The appropriate reporting process for PDT follows:  
  
The first stage is the intravenous injection of Photofrin. It is reported with the code for drug infusion (90784), and the J code (drug code) for Porfimer (J9600). Some insurers may prefer that you report the chemotherapy infusion codes (90780-90781). Check with your carrier to ensure appropriate reporting.
 
The second stage of this process 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. This is reported with the appropriate bronchoscopic code (31641, bronchoscopy; with destruction of tumor or relief of stenosis) and the appropriate PDT codes (96570 and 96571). The codes for PDT are add-on codes and can only be reported with a bronchoscopy code (31622-31656). Code 96570 is reported for the first 30 minutes of PDT, and 96571 is reported for each additional 15 minutes. Code 96571 cannot be reported without 96570.