Wiki Documentation required for 96567

[Ninememo]

Hello, I am auditing a new dermatologist who is billing 96567. Does anyone have a sample of a good note for this, or does anyone know what the documentation requirements are for this procedure? He is the first one to bill for this in our large teaching institution (which surprises me). Any help would be appreciated!

 

[TThivierge]

CPT 96567 photodynamic light therapy for treating skin musoca face or scalp problems. But cannot do any bx lesions, debridement orexcision in same area on same date. Alos can only do this treatment once a day and can be for premalignant lesions. Documentation should include body location description, HPI, ROS, if past history of skin problems Z86-z87 dx and then describe rationale on what he is treating and where on the body. Also medications used in past and prescribed add to documentation. If use consultation CPT add if new or est., CPT 96567, then add referring doctor name on claim. If dermatology is his or her specialty add modifier AF
Also photodynamic therapy is used to treat a variety of conditions, including:

• Bile duct cancer, also known as cholangiocarcinoma.
• Esophageal cancer.
• Lung cancer.
• Head, skin and neck cancers.
• Certain skin diseases, including acne, psoriasis, nonmelanoma skin cancer and precancerous skin changes, known as actinic keratosis.
• Bacterial, fungal and viral infections.

I hope this data helps you
Lady T

 

[admin@k2derm.com]

This is an "Incident-to code" which makes sense for your teaching institution. I found this in a search:

• Documentation:
  Thorough documentation is essential, including the name and designation of the person providing the service, and evidence of the supervising physician's involvement in the patient's care.
  
  
• State Laws:
  Incident-to billing rules can vary by state, so it's crucial to be aware of specific state regulations.
  
  
• Commercial Payers:
  While primarily a Medicare rule, some commercial payers may also allow or require similar billing practices.