How To Use CPT Code 96574

CPT 96574 describes the procedure of debridement of premalignant hyperkeratotic lesions followed by photodynamic therapy using a photosensitizing drug and specific wavelengths of light. This article will cover the description, procedure, qualifying circumstances, appropriate usage, documentation requirements, billing guidelines, historical information, similar codes and billing examples.

1. What is CPT Code 96574?

CPT 96574 can be used to report the removal of precancerous hyperkeratotic skin lesions followed by photodynamic therapy. This procedure involves the application of a photosensitizing drug to the lesion, which is then exposed to specific wavelengths of light to destroy the abnormal cells. It is important to note that CPT 96574 can only be reported once per day.

2. Official Description

The official description of CPT code 96574 is: ‘Debridement of premalignant hyperkeratotic lesion(s) followed with photodynamic therapy by external application of light to destroy premalignant lesions of the skin and adjacent mucosa with application and illumination/activation of photosensitizing drug(s) provided by a physician or other qualified health care professional, per day.’

3. Procedure

1. The physician or qualified health care professional explains the potential risks and benefits of the treatment to the patient.
2. The hyperkeratotic premalignant skin lesion is removed by the provider.
3. A photosensitizing drug is administered to the area where the lesion was removed.
4. The drug is absorbed by the abnormal cells, which retain the drug for a longer period than normal cells.
5. The patient is asked to return after a specific time period to ensure most of the drug remains in the abnormal cells.
6. The area is exposed to light of specific wavelengths to activate the drug.
7. The activated drug destroys the abnormal cells, effectively treating the premalignant lesions.

4. Qualifying circumstances

CPT 96574 is used for the removal of hyperkeratotic skin lesions that appear precancerous, followed by photodynamic therapy. The procedure must be performed by a physician or other qualified health care professional. It is important to note that CPT 96574 should not be reported in conjunction with CPT codes 96567 and 96573 for the same anatomic area.

5. When to use CPT code 96574

CPT code 96574 should be used when a physician or qualified health care professional performs the debridement of premalignant hyperkeratotic lesions followed by photodynamic therapy using a photosensitizing drug and specific wavelengths of light. It is important to remember that this code can only be reported once per day.

6. Documentation requirements

To support a claim for CPT 96574, the following documentation is required:

• Patient’s diagnosis and indication for the procedure
• Description of the hyperkeratotic lesion(s) removed
• Details of the photosensitizing drug used
• Date of the procedure
• Start and end time of the procedure
• Specific wavelengths of light used for photodynamic therapy
• Progress made by the patient
• Signature of the physician or qualified health care professional performing the procedure

7. Billing guidelines

When billing for CPT 96574, ensure that the procedure is performed by a physician or qualified health care professional. It is important to note that CPT 96574 should not be reported with CPT codes 96567 and 96573 for the same anatomic area. Additionally, it is recommended to review the location of the testing and consider the appropriate coding for the professional and technical components of the procedure.

8. Historical information

CPT 96574 was added to the Current Procedural Terminology system on January 1, 2018. There have been no updates to the code since its addition.

9. Examples

1. A physician performs debridement of a precancerous hyperkeratotic lesion on a patient’s face, followed by photodynamic therapy using a photosensitizing drug and specific wavelengths of light.
2. A qualified health care professional removes a precancerous hyperkeratotic lesion on a patient’s arm and administers a photosensitizing drug. The patient returns after the appropriate time period for photodynamic therapy.
3. A physician performs debridement of multiple precancerous hyperkeratotic lesions on a patient’s back, followed by photodynamic therapy using a photosensitizing drug and specific wavelengths of light.
4. A qualified health care professional removes a precancerous hyperkeratotic lesion on a patient’s leg and administers a photosensitizing drug. The patient returns for photodynamic therapy at a later date.
5. A physician performs debridement of a precancerous hyperkeratotic lesion on a patient’s scalp, followed by photodynamic therapy using a photosensitizing drug and specific wavelengths of light.
6. A qualified health care professional removes a precancerous hyperkeratotic lesion on a patient’s chest and administers a photosensitizing drug. The patient returns after the appropriate time period for photodynamic therapy.
7. A physician performs debridement of a precancerous hyperkeratotic lesion on a patient’s hand, followed by photodynamic therapy using a photosensitizing drug and specific wavelengths of light.
8. A qualified health care professional removes a precancerous hyperkeratotic lesion on a patient’s leg and administers a photosensitizing drug. The patient returns for photodynamic therapy at a later date.
9. A physician performs debridement of a precancerous hyperkeratotic lesion on a patient’s face, followed by photodynamic therapy using a photosensitizing drug and specific wavelengths of light.