Phototherapy remains a vital and cost-effective treatment option for several dermatoses, including psoriasis and various skin conditions. Despite the rise in popularity of biologics, phototherapy continues to play a crucial role, serving as a prerequisite for biologic therapy and the primary treatment for specific patient groups [1].
In this comprehensive guide, we will delve into the intricacies of phototherapy CPT codes, ensuring accurate reporting and adherence to documentation requirements.
I. Understanding Phototherapy
Phototherapy, also known as light therapy, utilizes specific wavelengths of light to treat various dermatological conditions. It involves the controlled exposure of the skin to ultraviolet (UV) light, which can be delivered using different methods and technologies. Phototherapy offers notable benefits, including efficacy, affordability, and safety, making it an indispensable treatment modality.
II. Key Phototherapy CPT Codes
To properly report phototherapy services, understanding the relevant Current Procedural Terminology (CPT) codes is essential. The following are key CPT codes associated with phototherapy:
1. CPT Code 96910: Photochemotherapy with tar and UVB
- This code is used when phototherapy involves the application of a chemical agent (tar) in conjunction with ultraviolet B (UVB) light [1]
2. CPT Code 96900: Actinotherapy
- Actinotherapy refers to the therapeutic use of ultraviolet light without the addition of any chemical agent. This code covers pure UVB therapy [1]
3. CPT Code 96920: Photochemotherapy with psoralen and UVA (PUVA)
- PUVA involves the administration of psoralen, a photosensitizing agent, followed by exposure to UVA light. This code encompasses the combination of psoralen and UVA therapy [1]
III. Differentiating Actinotherapy and Photochemotherapy
Distinguishing between actinotherapy and photochemotherapy is crucial, as the addition of a chemical agent significantly impacts the coding and documentation requirements. Actinotherapy (CPT code 96900) focuses on pure UVB light treatment without any chemical agents, whereas photochemotherapy involves the use of a chemical agent in conjunction with light therapy [1]
IV. Coding Tips and Documentation
Accurate coding and comprehensive documentation are vital for successful reimbursement and audit defense. Here are some key coding tips and documentation guidelines for phototherapy services:
1. Code Selection:
Choose the appropriate CPT code based on the specific phototherapy modality used and the presence or absence of chemical agents.
- CPT codes 96910, 96900, and 96920 are commonly used for different types of phototherapy.
2. Medical Necessity:
Ensure that the medical necessity of phototherapy is well-documented in the patient's medical record. Include information on the condition being treated, previous therapies attempted, and the response to those treatments.
3. Duration and Intensity:
Document the duration and intensity of each phototherapy session accurately. Specify the treatment time, irradiance level, and any variations based on patient characteristics.
4. Standard Operating Procedures:
Develop written standard operating procedures (SOPs) that outline the protocols for each phototherapy service. These SOPs should include details on patient preparation, treatment parameters, and follow-up care.
5. Detailed Documentation:
Maintain detailed documentation in medical records, including the patient's demographics, relevant history, physical examination findings, and progress notes. Document any adverse events, patient responses, and adjustments made to treatment parameters.
V. Frequently Asked Questions (FAQs)
1. What is the CPT code for phototherapy?
- The CPT codes commonly used for reporting phototherapy services include 96910, 96900, 96920, and others.
2. Are there specific codes for psoriasis treatment?
- Yes, phototherapy for psoriasis can be reported using the relevant phototherapy CPT codes, such as 96910, 96900, and 96920.
3. Is phototherapy an effective treatment option?
- Phototherapy has been proven to be a safe and effective treatment modality for various dermatological conditions, including psoriasis and vitiligo [2]
VI. Conclusion
Phototherapy remains a valuable treatment option for dermatological conditions, offering an effective and cost-efficient alternative to biologic therapies. By accurately understanding and utilizing the appropriate CPT codes for phototherapy, healthcare professionals can ensure proper documentation, reimbursement, and compliance with insurance requirements. Remember to refer to official coding guidelines and consult with coding experts when necessary to ensure accurate coding and reporting of phototherapy procedures.
References:
[1]. Phototherapy Coding and Documentation in the Time of Biologics
[2]. Phototherapy and Photochemotherapy (PUVA) for Skin Conditions - Medical Clinical Policy Bulletins | Aetna
http://www.cms1500claimbilling.com/2017/03/cpt-code-96910-96912-96920.html