How To Use CPT Code 96571

CPT 96571 describes the procedure of photodynamic therapy by endoscopic application of light to ablate abnormal tissue via activation of photosensitive drug(s), with each additional 15 minutes listed separately in addition to the code for endoscopy or bronchoscopy procedures of the lung and gastrointestinal tract. 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 96571?

CPT 96571 is used to describe the procedure of photodynamic therapy by endoscopic application of light to ablate abnormal tissue via activation of photosensitive drug(s). This code is used when the provider administers a photosensitizing drug to abnormal tissue and exposes it to a specific wavelength of light for each additional 15 minutes, over a period of 38 to 52 minutes. The purpose of this procedure is to destroy cancerous or precancerous cells in the body.

2. Official Description

The official description of CPT code 96571 is: ‘Photodynamic therapy by endoscopic application of light to ablate abnormal tissue via activation of photosensitive drug(s); each additional 15 minutes (List separately in addition to code for endoscopy or bronchoscopy procedures of lung and gastrointestinal tract).’ Notes: (For 23-37 minutes of service, use 96570. For 38-52 minutes of service, use 96570 in conjunction with 96571) (96570, 96571 are to be used in addition to bronchoscopy, endoscopy codes) (Use 96570, 96571 in conjunction with 31641, 43229 as appropriate).

3. Procedure

1. The provider applies a photosensitizing drug to abnormal tissue during a primary endoscopy or bronchoscopy.
2. The provider exposes the area to light for periods of 15 minutes over a period of 38 to 52 minutes.
3. The drug in the tissue absorbs the light and produces an active form of oxygen that destroys the abnormal cells.
4. The provider continues with the endoscopy or bronchoscopy procedure.

4. Qualifying circumstances

CPT 96571 is performed when there is a need to destroy cancerous or precancerous cells in abnormal tissue. The procedure is typically performed during a primary endoscopy or bronchoscopy. The patient must have abnormal tissue that can be treated with photodynamic therapy, and the provider must administer a photosensitizing drug to the tissue. The procedure is performed for a period of 38 to 52 minutes, with each additional 15 minutes listed separately.

5. When to use CPT code 96571

CPT code 96571 should be used when the provider performs photodynamic therapy by endoscopic application of light to ablate abnormal tissue via activation of photosensitive drug(s) for a period of 38 to 52 minutes. This code should be used in addition to the primary code for the endoscopy or bronchoscopy procedure. It should not be reported without an appropriate primary code and the code for the first 30 minutes of photodynamic therapy (CPT code 96570).

6. Documentation requirements

To support a claim for CPT code 96571, the provider must document the following information:

• Diagnosis indicating the need for photodynamic therapy
• Specific details of the procedure, including the photosensitizing drug used and the duration of the therapy
• Date, start and end time of the procedure
• Any additional relevant information, such as the primary endoscopy or bronchoscopy procedure performed
• Signature of the provider performing the procedure

7. Billing guidelines

When billing for CPT code 96571, ensure that the procedure is performed during a primary endoscopy or bronchoscopy. Report this code once for each 15-minute period of photodynamic therapy, up to a total of 38 to 52 minutes. It should be listed separately in addition to the codes for the first 30 minutes of treatment and the primary code for the endoscopy or bronchoscopy. It is important to use the appropriate primary code based on the specific procedure performed.

8. Historical information

CPT code 96571 was added to the Current Procedural Terminology system on January 1, 2000. There was a code change on January 1, 2010, which modified the description to include the ablation of abnormal tissue in the lung and esophagus.

9. Examples

1. A gastroenterologist performs photodynamic therapy to ablate abnormal tissue in the esophagus for a period of 45 minutes during an endoscopy procedure.
2. An oncologist administers a photosensitizing drug and exposes abnormal lung tissue to light for 40 minutes during a bronchoscopy procedure.
3. A pulmonologist performs photodynamic therapy to destroy cancerous cells in the bronchi for a period of 50 minutes during a bronchoscopy procedure.
4. A surgeon uses photodynamic therapy to ablate abnormal tissue in the gastrointestinal tract for a period of 48 minutes during an endoscopy procedure.
5. An otolaryngologist performs photodynamic therapy to treat precancerous cells in the larynx for a period of 42 minutes during an endoscopy procedure.