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Photodynamic therapy (PDT) is a medical treatment that utilizes a combination of a light-sensitive drug and light exposure to target and destroy abnormal tissue, particularly in the lungs and gastrointestinal tract. The process begins with the administration of a photosensitive drug, such as Photofrin, which is delivered intravenously approximately 48 hours before the procedure. This drug is absorbed by various tissues in the body, including cancerous or abnormal cells. Following this preparation, a separate endoscopic procedure, such as gastrointestinal endoscopy or bronchoscopy, is performed. During this procedure, a low-intensity laser is applied to the affected area, where the photosensitive drug has accumulated. The interaction between the light and the drug triggers a reaction that leads to the destruction of the abnormal tissue. The CPT® Code 96570 specifically refers to the first 30 minutes of this photodynamic therapy, which is reported separately in addition to the codes for the endoscopic or bronchoscopy procedures being performed. For any additional time spent on PDT beyond the initial 30 minutes, CPT® Code 96571 should be used, which accounts for each additional 15-minute increment of therapy.
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The indications for photodynamic therapy (PDT) using CPT® Code 96570 include the treatment of abnormal or cancerous tissue located in the lungs or gastrointestinal tract. This therapy is particularly indicated for patients with specific types of malignancies or lesions that are responsive to light-activated treatment, where traditional surgical methods may not be viable or effective.
The procedure for photodynamic therapy involves several critical steps that ensure the effective treatment of abnormal tissue. First, the patient receives an intravenous injection of a light-sensitive drug, such as Photofrin, approximately 48 hours prior to the PDT procedure. This drug is designed to accumulate in abnormal or cancerous tissues, making them more susceptible to the subsequent light application. Following this preparation period, the patient undergoes a separate endoscopic procedure, which may involve either gastrointestinal endoscopy or bronchoscopy, depending on the location of the abnormal tissue. During this endoscopic procedure, a low-intensity laser is carefully directed at the targeted area where the photosensitive drug has been absorbed. The laser light activates the drug, leading to a photochemical reaction that results in the destruction of the abnormal tissue. The initial application of PDT is coded using CPT® Code 96570 for the first 30 minutes of treatment, and any additional time spent on the procedure is reported using CPT® Code 96571, which accounts for each subsequent 15-minute increment.
After the completion of photodynamic therapy, patients may require monitoring for any immediate adverse effects related to the procedure. It is essential to observe the treated area for signs of inflammation or other complications. Patients may also experience photosensitivity due to the light-activated drug, necessitating precautions to avoid exposure to bright light for a specified period following the treatment. Recovery times can vary based on the extent of the procedure and the individual patient's response, but follow-up appointments are typically scheduled to assess the effectiveness of the therapy and to monitor for any recurrence of abnormal tissue.
| Short Descr | PHOTODYNMC TX 30 MIN ADD-ON | Medium Descr | PDT NDSC ABL ABNOR TISS VIA ACTIVJ RX 30 MIN | Long Descr | Photodynamic therapy by endoscopic application of light to ablate abnormal tissue via activation of photosensitive drug(s); first 30 minutes (List separately in addition to code for endoscopy or bronchoscopy procedures of lung and gastrointestinal tract) | Status Code | Active Code | Global Days | ZZZ - Code Related to Another Service | PC/TC Indicator (26, TC) | 0 - Physician Service 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) | 1 - Statutory 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 | Items and Services Packaged into APC Rates | Type of Service (TOS) | 2 - Surgery | Berenson-Eggers TOS (BETOS) | P8B - Endoscopy - upper gastrointestinal | MUE | 1 | CCS Clinical Classification | 174 - Other non-OR therapeutic procedures on skin and breast |
This is an add-on code that must be used in conjunction with one of these primary codes.
| 31641 | MPFS Status: Active Code APC J1 ASC A2 CPT Assistant Article Illustration for Code Bronchoscopy, rigid or flexible, including fluoroscopic guidance, when performed; with destruction of tumor or relief of stenosis by any method other than excision (eg, laser therapy, cryotherapy) | 43229 | MPFS Status: Active Code APC J1 ASC J8 Esophagoscopy, flexible, transoral; with ablation of tumor(s), polyp(s), or other lesion(s) (includes pre- and post-dilation and guide wire passage, when performed) | 43270 | CPT Resequenced MPFS Status: Active Code APC J1 ASC J8 Esophagogastroduodenoscopy, flexible, transoral; with ablation of tumor(s), polyp(s), or other lesion(s) (includes pre- and post-dilation and guide wire passage, when performed) | 96571 | Addon Code MPFS Status: Active Code APC N PUB 100 CPT Assistant Article 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) |
| 52 | Reduced services: under certain circumstances a service or procedure is partially reduced or eliminated at the discretion of the physician or other qualified health care professional. under these circumstances the service provided can be identified by its usual procedure number and the addition of modifier 52, signifying that the service is reduced. this provides a means of reporting reduced services without disturbing the identification of the basic service. note: for hospital outpatient 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. | 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. | 78 | Unplanned return to the operating/procedure room by the same physician or other qualified health care professional following initial procedure for a related procedure during the postoperative period: it may be necessary to indicate that another procedure was performed during the postoperative period of the initial procedure (unplanned procedure following initial procedure). when this procedure is related to the first, and requires the use of an operating/procedure room, it may be reported by adding modifier 78 to the related procedure. (for repeat procedures, see modifier 76.) | AQ | Physician providing a service in an unlisted health professional shortage area (hpsa) | GC | This service has been performed in part by a resident under the direction of a teaching physician | Q1 | Routine clinical service provided in a clinical research study that is in an approved clinical research study |
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| 2011-01-01 | Changed | Short description changed. Guideline information changed. |
| 2010-01-01 | Changed | Code description changed. |
| 2000-01-01 | Added | First appearance in code book in 2000. |
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