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Kathleen Posted Wed 28th of June, 2017 21:27:50 PM
The physician uses code 96567. The patient is large and the light is repositioned during the treatment. Sometimes hands are done and arms and repositioning is needed to cover the area. This code is confusing because it talks about one light exposure session. I understand it is not by lesion but what about by region? Does this mean that 96567 can be billed only once no matter how large an area or how many different body parts are treated? How far apart would sessions need to be? A day apart? Thank you.
SuperCoder Answered Thu 29th of June, 2017 03:14:19 AM

This code is reported once per light exposure session, no matter how many lesions the dermatologist treats or how long the session lasts.

Coding for PDT can be complex, since the procedure usually takes place over two days. On the first day, when the dermatologist applies the drug, use a HCPCS code for the supply, for example, report J7308 for aminolevulinic acid. You may also report an EM code on this day, but be sure to check with your carrier. Report 96567, when the patient returns after 14 to 18 hours for the light exposure.

Please find below SuperCoder link for more understanding on the topic:

Kathleen Posted Mon 17th of July, 2017 20:00:00 PM
That was not helpful and I disagree since multiple regions can be done at one time and some ins providers recognize this and allow multiple units. Since the 2011 article you refer to delivery has changed as has the wait time. The acid is often done same day as the procedure and more than one area is done.
SuperCoder Answered Tue 18th of July, 2017 02:44:04 AM

Code descriptor of CPT code 96567 itself states per session exposure, which means expose performed on a single body part or whole area area would be billed as a single unit. This code is session based, not lesion based or region based.

MUE (Medicare Unlikely Edits) of this code is also 1 which means this code cannot be billed for more than 1 units on a billed DOS.

Some private payers may pay for more than 1 unit per session but as per coding guidelines this code is paid per session.



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