AMA CPT® Assistant - 2018 Issue 2 (February)
Photodynamic Therapy (February 2018)
February 2018 page 10 Photodynamic Therapy Current Procedural Terminology (CPT®) code 96567 (photodynamic therapy) was identified by the Centers for Medicare & Medicaid Services (CMS) in a screen of high expenditure services. In the Medicare Physician Fee Schedule final rule for 2016, CMS indicated that the work and practice expense for this service should be reviewed. Code 96567—first included in CPT 2002—is not valued to include physician work. More recently, the stakeholder specialties provided information that physicians may be involved in the delivery of care to patients who receive photodynamic therapy. As a result, two new codes (96573...
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Article Overview
This article explains a 2018 CPT update on photodynamic therapy and why the changes were reviewed by CMS. It is aimed at coders, billing staff, and clinicians who work with dermatology-related procedures and need a general understanding of the revised CPT Medicine subsection guidance, associated notes, and related reporting considerations.
Why This Topic Matters
The update affects how photodynamic therapy services are categorized in CPT and clarifies the overall scope of the 2018 changes in a specialty area where correct code selection and documentation awareness matter.
Article Sections
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Photodynamic Therapy
Introduces the CPT update, the CMS review context, and the overall scope of the 2018 changes discussed in the article.
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Photodynamic Therapy
Presents the photodynamic therapy code set discussion and the general reporting framework addressed in the article.
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Guidelines
Summarizes the revised guideline material and related restrictions, along with the broader coding context for the service.
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Coding Tip
Highlights general coding reminders associated with the photodynamic therapy updates.
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Coding Tip
Provides additional general guidance tied to the service timing and related reporting considerations.
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Clinical Example (96573)
Contains a clinical example paired with procedure description material for one of the photodynamic therapy codes.
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Description of Procedure (96573)
Describes the procedural workflow associated with the clinical example for the related photodynamic therapy service.
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Coding Tip
Offers a final general reminder about a related reporting limitation.
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Clinical Example (96574)
Contains a clinical example paired with procedure description material for another photodynamic therapy code.
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Description of Procedure (96574)
Describes the procedural workflow associated with the second clinical example in the article.
What You Will Learn
- How the article frames the 2018 CPT changes for photodynamic therapy
- Which broad reporting distinctions the update is intended to clarify
- What general guideline and tip content accompanies the CPT revision
- How the article presents clinical examples and procedure descriptions for related services
Who Should Read This
- Medical coders
- Billing and reimbursement staff
- Dermatology practices
- Physicians and qualified health care professionals
- Coding auditors and compliance staff
Codes Discussed
Code Ranges Discussed
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