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Photodynamic therapy (PDT) is a medical procedure that employs the use of photosensitive or photoreactive chemicals in conjunction with light to effectively target and destroy premalignant lesions located on the skin and adjacent mucosa. This therapy involves the topical application of these photosensitive agents to all identified lesions within a designated anatomical area, which may include regions such as the face or scalp. Prior to the application of the photosensitive drugs, the lesions may require preparation, which can involve the removal of any overlying crust or scale to enhance the effectiveness of the treatment. Following the application of the photosensitive chemicals, the lesions are subjected to irradiation using light of a specific wavelength. This light serves to activate the photoreactive chemicals, leading to a photochemical reaction that results in the destruction of the targeted lesions. The CPT® Code 96567 is utilized to report this procedure, which is performed once per day, and it is important to note that this code is applicable when the treatment is conducted without the direct involvement of a physician or other qualified healthcare professional in the procedure.
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The indications for photodynamic therapy (PDT) as described by CPT® Code 96567 include the treatment of premalignant lesions of the skin and adjacent mucosa. These lesions may present in various forms and are typically identified as areas that have the potential to develop into malignant conditions if left untreated. PDT is particularly indicated for patients who require a non-invasive treatment option to address these lesions effectively.
The procedure for photodynamic therapy (PDT) involves several key steps that ensure the effective treatment of premalignant lesions. Initially, the lesions are prepared for treatment, which may include the careful removal of any overlying crust or scale. This preparation step is crucial as it allows for better penetration and activation of the photosensitive drugs that will be applied. Following this, the photosensitive agent is applied topically to all lesions within the specified anatomical area, such as the face or scalp. Once the application is complete, the next step involves the irradiation of the lesions with light of an appropriate wavelength. This light exposure activates the photoreactive chemicals, initiating a photochemical reaction that leads to the destruction of the premalignant lesions. It is important to note that this entire process is reported under CPT® Code 96567, which is applicable for each day the therapy is administered.
After the completion of photodynamic therapy, patients may experience some localized reactions, which can include redness, swelling, or discomfort in the treated area. These reactions are typically mild and resolve over time. It is essential for patients to follow any post-procedure care instructions provided by their healthcare provider to ensure optimal healing and to monitor for any adverse effects. Additionally, patients may be advised to avoid sun exposure and to use sun protection on the treated areas to prevent complications and support recovery.
| Short Descr | PDT DSTR PRMLG LES SKN | Medium Descr | PDT DSTR PRMLG LES SKN ILLUM/ACTIVJ PER DAY | Long Descr | 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 | Status Code | Active Code | Global Days | XXX - Global Concept Does Not Apply | PC/TC Indicator (26, TC) | 5 - Incident To Code | Multiple Procedures (51) | 0 - No payment adjustment rules for multiple procedures apply. | Bilateral Surgery (50) | 0 - 150% payment adjustment for bilateral procedures does NOT apply. | Physician Supervisions | 09 - Concept does not apply. | Assistant Surgeon (80, 82) | 0 - Payment restriction for assistants at surgery applies to this procedure... | Co-Surgeons (62) | 0 - Co-surgeons not permitted for this procedure. | Team Surgery (66) | 0 - Team surgeons not permitted for this procedure. | Diagnostic Imaging Family | 99 - Concept Does Not Apply | APC Status Indicator | STV-Packaged Codes | Type of Service (TOS) | 1 - Medical Care | Berenson-Eggers TOS (BETOS) | P4E - Eye procedure - other | MUE | 1 | CCS Clinical Classification | 174 - Other non-OR therapeutic procedures on skin and breast |
| 59 | Distinct procedural service: under certain circumstances, it may be necessary to indicate that a procedure or service was distinct or independent from other non-e/m services performed on the same day. modifier 59 is used to identify procedures/services, other than e/m services, that are not normally reported together, but are appropriate under the circumstances. documentation must support a different session, different procedure or surgery, different site or organ system, separate incision/excision, separate lesion, or separate injury (or area of injury in extensive injuries) not ordinarily encountered or performed on the same day by the same individual. however, when another already established modifier is appropriate it should be used rather than modifier 59. only if no more descriptive modifier is available, and the use of modifier 59 best explains the circumstances, should modifier 59 be used. note: modifier 59 should not be appended to an e/m service. to report a separate and distinct e/m service with a non-e/m service performed on the same date, see modifier 25. | X4 | Episodic/focused services: for reporting services by clinicians who provide focused care on particular types of treatment limited to a defined period and circumstance; the patient has a problem, acute or chronic, that will be treated with surgery, radiation, or some other type of generally time-limited intervention; reporting clinician service examples include but are not limited to, the orthopedic surgeon performing a knee replacement and seeing the patient through the postoperative period | 79 | Unrelated procedure or service by the same physician or other qualified health care professional during the postoperative period: the individual may need to indicate that the performance of a procedure or service during the postoperative period was unrelated to the original procedure. this circumstance may be reported by using modifier 79. (for repeat procedures on the same day, see modifier 76.) | 24 | Unrelated evaluation and management service by the same physician or other qualified health care professional during a postoperative period: the physician or other qualified health care professional may need to indicate that an evaluation and management service was performed during a postoperative period for a reason(s) unrelated to the original procedure. this circumstance may be reported by adding modifier 24 to the appropriate level of e/m service. | 25 | Significant, separately identifiable evaluation and management service by the same physician or other qualified health care professional on the same day of the procedure or other service: it may be necessary to indicate that on the day a procedure or service identified by a cpt code was performed, the patient's condition required a significant, separately identifiable e/m service above and beyond the other service provided or beyond the usual preoperative and postoperative care associated with the procedure that was performed. a significant, separately identifiable e/m service is defined or substantiated by documentation that satisfies the relevant criteria for the respective e/m service to be reported (see evaluation and management services guidelines for instructions on determining level of e/m service). the e/m service may be prompted by the symptom or condition for which the procedure and/or service was provided. as such, different diagnoses are not required for reporting of the e/m services on the same date. this circumstance may be reported by adding modifier 25 to the appropriate level of e/m service. note: this modifier is not used to report an e/m service that resulted in a decision to perform surgery. see modifier 57 for significant, separately identifiable non-e/m services, see modifier 59. | 53 | Discontinued procedure: under certain circumstances, the physician or other qualified health care professional may elect to terminate a surgical or diagnostic procedure. due to extenuating circumstances or those that threaten the well being of the patient, it may be necessary to indicate that a surgical or diagnostic procedure was started but discontinued. this circumstance may be reported by adding modifier 53 to the code reported by the individual for the discontinued procedure. note: this modifier is not used to report the elective cancellation of a procedure prior to the patient's anesthesia induction and/or surgical preparation in the operating suite. for outpatient hospital/ambulatory surgery center (asc) reporting of a previously scheduled procedure/service that is partially reduced or cancelled as a result of extenuating circumstances or those that threaten the well being of the patient prior to or after administration of anesthesia, see modifiers 73 and 74 (see modifiers approved for asc hospital outpatient use). | 58 | Staged or related procedure or service by the same physician or other qualified health care professional during the postoperative period: it may be necessary to indicate that the performance of a procedure or service during the postoperative period was: (a) planned or anticipated (staged); (b) more extensive than the original procedure; or (c) for therapy following a surgical procedure. this circumstance may be reported by adding modifier 58 to the staged or related procedure. note: for treatment of a problem that requires a return to the operating/procedure room (eg, unanticipated clinical condition), see modifier 78. | 76 | Repeat procedure or service by same physician or other qualified health care professional: it may be necessary to indicate that a procedure or service was repeated by the same physician or other qualified health care professional subsequent to the original procedure or service. this circumstance may be reported by adding modifier 76 to the repeated procedure or service. note: this modifier should not be appended to an e/m service. | AQ | Physician providing a service in an unlisted health professional shortage area (hpsa) | CR | Catastrophe/disaster related | E2 | Lower left, eyelid | GA | Waiver of liability statement issued as required by payer policy, individual case | GC | This service has been performed in part by a resident under the direction of a teaching physician | GW | Service not related to the hospice patient's terminal condition | LT | Left side (used to identify procedures performed on the left side of the body) | PD | Diagnostic or related non diagnostic item or service provided in a wholly owned or operated entity to a patient who is admitted as an inpatient within 3 days | Q1 | Routine clinical service provided in a clinical research study that is in an approved clinical research study | Q6 | Service furnished under a fee-for-time compensation arrangement by a substitute physician or by a substitute physical therapist furnishing outpatient physical therapy services in a health professional shortage area, a medically underserved area, or a rural area | SA | Nurse practitioner rendering service in collaboration with a physician | XS | Separate structure, a service that is distinct because it was performed on a separate organ/structure | XU | Unusual non-overlapping service, the use of a service that is distinct because it does not overlap usual components of the main service |
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| 2018-01-01 | Changed | Long medium and short descriptions changed. |
| 2011-01-01 | Changed | Short description changed. |
| 2002-01-01 | Added | First appearance in code book in 2002. |
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