How To Use CPT Code 96567

CPT 96567 describes the procedure of photodynamic therapy by external application of light to destroy premalignant lesions of the skin and adjacent mucosa with the application and illumination/activation of photosensitive drug(s), per day. This article will cover the description, official description, procedure, qualifying circumstances, appropriate usage, documentation requirements, billing guidelines, historical information, similar codes and billing examples.

1. What is CPT Code 96567?

CPT 96567 can be used to describe the procedure of photodynamic therapy, which involves the application of light to destroy premalignant lesions of the skin and adjacent mucosa. This therapy utilizes photosensitive drugs that are activated by specific wavelengths of light to target and destroy abnormal cells. It is important to note that this code is used when the physician or other qualified healthcare professional is not directly involved in the delivery of the photodynamic therapy service.

2. Official Description

The official description of CPT code 96567 is: ‘Photodynamic therapy by external application of light to destroy premalignant lesions of the skin and adjacent mucosa with application and illumination/activation of photosensitive drug(s), per day. Use 96567 for reporting photodynamic therapy when the physician or other qualified healthcare professional is not directly involved in the delivery of the photodynamic therapy service.’

3. Procedure

1. The provider explains the potential risks and benefits of photodynamic therapy to the patient.
2. The provider applies a photosensitizing drug to the patient’s premalignant lesions.
3. The photosensitizing drug is absorbed by the abnormal cells, which retain the drug for a longer period compared to normal cells.
4. The patient is asked to return after a specific time period, allowing the drug to accumulate in the abnormal cells.
5. The provider exposes the area to a specific wavelength of light, activating the photosensitizing drug and producing an active form of oxygen that destroys the abnormal cells.

4. Qualifying circumstances

Photodynamic therapy using CPT 96567 is performed on patients with premalignant lesions of the skin and adjacent mucosa. These lesions are at risk of converting to cancer. The procedure involves the application and illumination/activation of photosensitive drugs. It is important to note that this code is used when the physician or other qualified healthcare professional is not directly involved in the delivery of the photodynamic therapy service.

5. When to use CPT code 96567

CPT code 96567 should be used when photodynamic therapy is performed by a provider who is not a physician or other qualified healthcare professional directly involved in the delivery of the service. This code is specifically for the external application of light to destroy premalignant lesions of the skin and adjacent mucosa using photosensitive drugs. It is important to ensure that the service meets the criteria outlined in the official description of CPT code 96567.

6. Documentation requirements

To support a claim for CPT code 96567, the provider must document the following information:

• Patient’s diagnosis of premalignant lesions
• Application and illumination/activation of photosensitive drugs
• Date of the procedure
• Start and end time of the procedure
• Details of the specific premalignant lesions treated
• Any additional relevant information or observations

7. Billing guidelines

When billing for CPT code 96567, it is important to ensure that the physician or other qualified healthcare professional is not directly involved in the delivery of the photodynamic therapy service. This code should be reported once per day, regardless of the number of applications. It is also important to follow any specific guidelines or requirements set forth by the payer. Additionally, consider any modifiers that may be necessary for accurate billing.

8. Historical information

CPT code 96567 was added to the Current Procedural Terminology system on January 1, 2002. It underwent a code change on January 1, 2018, to include the destruction of premalignant and/or malignant lesions of the skin and adjacent mucosa by activation of photosensitive drugs during each phototherapy exposure session.

9. Examples

1. A dermatologist performing photodynamic therapy to destroy premalignant lesions on a patient’s face.
2. A dentist using photodynamic therapy to treat premalignant lesions in the oral cavity.
3. An otolaryngologist utilizing photodynamic therapy to target premalignant lesions in the nasal cavity.
4. A gynecologist performing photodynamic therapy to treat premalignant lesions on the cervix.
5. A gastroenterologist using photodynamic therapy to destroy premalignant lesions in the esophagus.
6. A urologist utilizing photodynamic therapy to target premalignant lesions in the bladder.
7. A plastic surgeon performing photodynamic therapy to treat premalignant lesions on the hands.
8. An ophthalmologist using photodynamic therapy to destroy premalignant lesions on the eyelids.
9. An oncologist utilizing photodynamic therapy to target premalignant lesions in the lungs.
10. A podiatrist performing photodynamic therapy to treat premalignant lesions on the feet.