Fwd: CPT 96567 Photodynamic tx, skin; BLU-UR light

[Guest guest]

For those wondering what I am talking about, see bottom of e-mail.

, I was under the impression the Acne had to be blue wave length - and moderately powerful -- 400-450 nm

Although the aesthetic nurse mentioned just having them step outside for sun exposure.

I was concerned about billing for photodynamic therapy to insurance/medicare, but not treating with actual blue wavelength light and whether this could actually be consider the full PDT treatment for billing purposes.

thanks for the feedback.

Locke, MD

==============================

 

magnetdoctor@...reply-to

to

dateThu, May 27, 2010 at 10:32 AMsubjectRe: Photodynamic Therapy --> Levulan and Blue Light Treatments; Also Blue Light Treatments for Acnemailing list<.yahoogroups.com> Filter messages from this mailing list

  ,  I haven't used PDT with Levulan in over a year.  But was doing it successfully for acne, and actinic keratosis, with my IPL light.  Had gone to a Cosmetic Derm conference in Maui where they talked about it and stated could be any intense light source.  My Cutera laser/IPL, also I think gave me some articles on it.  I will look around and see if I still have them. Basically, you really need to do either late in pm, or in fall/winter.  They have to stay out of even indirect sunlightthru a window) for 48 hr after they have the treatment.  We had a teenager who had failed Accutane, ( actually attempted suicide on it), and the poor thing her face was just pustules from forehead to chin.  It took more than 3 treatments, but she got a fabulous result.  We have a before and after she allows us to use for example, and in any promotion.  You can't believe the difference.  We never billed insurance, as the advice we got from the speaker, and other's at the conference was it didn't cover for acne, but would cover the cost of the Levulan at least for actinic keratosis.  Only did one client for actinic keratosis, also good result, but charged her cash. Do not have a blu light, didn't feel it was worth the cost or the floor space. 

  Cote' MDMD Cote' Medical, Laser, and Spa 

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The BLU-U® light alone is FDA cleared for light alone treatment of moderate inflammatory acne. The BLU-U Blue Light Photodynamic Therapy Illuminator, in combination with the Levulan® Kerastick® for Topical Solution, 20% is indicated for the treatment of minimally to moderately thick actinic keratoses of the face or scalp. Do not use this device with other photosensitizing drugs. Refer to the Levulan Kerastick for Topical Solution, 20% Prescribing Information for additional information.

When using the BLU-U for acne, do not use this device with photosensitizing drugs.

======================================================

 

Medicare is paying -- CPT 96567   Photodynamic tx, skin --  $127.35 

 

 

Searching Criteria

Year

2010

HCPC

96567

Modifier

All modifiers

r

04102 COLORADO

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Modifier

Short Description

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Facility Price

Non-Facility Limiting Charge

Facility Limiting Charge

GPCI Work

GPCI PE

GPCI MP

Proc Stat

WORK RVU

NA Flag for Trans Non-Fac PE RVU

Transitioned Non-Fac PE RVU

NA Flg for Fully Imp Non-Fac PE RVU

Fully Implemented Non-Fac PE RVU

NA Flag for Trans Facility PE RVU

Transitioned Facility PE RVU

NA Flag for Fully Imp Fac PE RVU

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MP RVU

Transitioned Non-Fac Total

Transitioned Facility Total

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OPPS Non-Facility Payment Amount

OPPS Facility Payment Amount

Non-Fac PE Used for OPPS Pmt Amt

Facility PE Used for OPPS Pmt Amt

Malpractice Used for OPPS Pmt Amt

96567

    

Photodynamic tx, skin

0410201

$116.57

NA

$127.35

NA

0.986

0.992

0.641

A

0

    

3.25

    

3.17

NA

3.25

NA

3.17

0.01

3.26

3.26

3.18

3.18

5

XXX

0

0

0

0

0

0

0

0

09

    

    

36.0846

    

99

NA

NA

0

0

0

 

 

This is from 2004

 

http://www.cignagovernmentservices.com/partb/pubs/mb/2004/04_10/PDFs/NC_2004-10.pdf

 

http://www.carefirst.com/pages/mdmedicare/pdf/MM3312.pdf

 

 

http://www.cignagovernmentservices.com/partb/pubs/mb/2004/04_10/PDFs/NC_2004-10.pdf

 

 

http://www.healthlink.com/provider/medpolicy/policies/MED/photodynamic_tx.html

 

Photodynamic Therapy with Topical 5-Aminolevulinic Acid (5-ALA or Levulan®) and Exposure to Blue Light Illumination using the BLU-UTM Blue Light Photodynamic Therapy Illuminator

 

Medically Necessary:

 

Photodynamic therapy with topical 5-Aminolevulinic Acid (5-ALA or Levulan®) and exposure to blue light illumination using the BLU-UTM Blue Light Photodynamic Therapy Illuminator is considered medically necessary for the treatment of non-hyperkeratotic actinic keratoses of the face or scalp.

 

Investigational/Not Medically Necessary:

 

Photodynamic therapy with topical 5-ALA and exposure to blue light illumination using the BLU-UTM Blue Light Photodynamic Therapy Illuminator is considered investigational/not medically necessary for all other dermatologic applications not identified above as medically necessary.  This includes, but is not limited to, use for the treatment of grade 3 (thick) hyperkeratotic actinic keratoses, or of lesions on the trunk or extremities. 

 

Note: For the treatment of acne vulgaris, please refer to Medical Policy MED.00063 Treatment of Acne Vulgaris Using Pulsed Dye Laser or Photodynamic Therapy. 

 

========================

http://www.cigna.com/customer_care/healthcare_professional/coverage_positions/medical/mm_0033_coveragepositioncriteria_photodynamic_therapy_for_dermatologic_conditions.pdf

 

 

==========================

http://www.bcbsms.com/com/bcbsms/apps/PolicySearch/views/ViewPolicy.php? & blank & action=viewPolicy & noprint=yes & path=%2Fpolicy%2Femed%2FDermatologic+Applications+of+Photodynamic+Therapy.html & keywords=%3C!123-321!%3E & source=emed & page=id=169 & me=index.php

 

CODE REFERENCE

This is not intended to be a comprehensive list of codes. Some covered procedure codes may have multiple descriptions. Coverage will only be made for covered codes when used for services outlined within the policy statement section.

Covered Codes

Code Number

Description

CPT-4

96567

Photodynamic therapy by external application of light to destroy premalignant and/or malignant lesions of the skin and adjacent mucosa (e.g., lip) by activation of photosensitive drug(s), each phototherapy exposure session. (added 1-23-2002) (moved to covered 8-3-2007)

ICD-9 Procedure

99.83

Other phototherapy (added 5-28-2002) (moved to covered 8-3-2007)

ICD-9 Diagnosis

173.0, 173.1, 173.2, 173.3, 173.4, 173.5, 173.6, 173.7, 173.8, 173.9

Other malignant neoplasm of skin (added 8-3-2007)

232.0, 232.1, 232.2, 232.3, 232.4, 232.5, 232.6, 232.7, 232.8, 232.9

Carcinoma in situ of skin (added 8-3-2007)

702.0

Actinic keratosis (added 8-3-2007)

HCPCS

J7308

Aminolevulinic acid HCl for topical administration, 20% single unit dosage form (354 mg) (Levulan Kerastick for topical solution) (added 1-23-2002) (moved to covered 8-3-2007)

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http://www.dusapharma.com/levulan-photodynamic-therapy.html

http://www.dusapharma.com/kerastick.html

Levulan® Photodynamic Therapy - A Unique Therapeutic Approach to Manage Actinic Keratoses

  

Targeted therapy destroys Grade I or II Actinic Keratoses1,2,3,4,5

Levulan PDT is a 2-part treatment:

1.  Application of Levulan® Kerastick® Topical Solution, 20%

2.  BLU-U® Blue Light Photodynamic Illumination  

   *  Highly targeted spot treatment allows precise therapeutic control

 

 

Important Risk InformationLevulan® Kerastick® plus blue light illumination using the BLU-U® blue light photodynamic therapy illuminator is indicated for the treatment of minimally to moderately thick actinic keratoses (Grade 1 or 2) of the face or scalp.

Application of Levulan® Kerastick® should involve either scalp or face lesions, but not both simultaneously. Levulan® Kerastick® should not be applied to the periorbital area or allowed to contact ocular or mucosal surfaces.

Contraindicated in patients with cutaneous photosensitivity at wavelengths of 400-450 nm, porphyria, or known allergies to porphyrins, and in patients with known sensitivity to any of the components of the Levulan Kerastick for Topical Solution.

Levulan® Kerastick® has not been tested on patients with inherited or acquired coagulation defects. It is possible that concomitant use of other known photosensitizing agents might increase the photosensitivity reaction of actinic keratoses treated with the Levulan® Kerastick®.

Patients should avoid exposure of the photosensitive treatment sites to sunlight or bright indoor light prior to blue light treatment. Exposure may result in a stinging and/or burning sensation and may cause erythema or edema of the lesions. Patients should protect treated lesions from the sun by wearing a wide-brimmed hat or similar head covering of light-opaque material. Sunscreens will not protect against photosensitivity reactions caused by visible light.

Transient local symptoms of stinging and/or burning, itching, erythema, and edema were observed in all clinical studies. Severe stinging and/or burning at one or more lesions being treated was reported by at least 50% of patients at some time during treatment. However, less than 3% of patients discontinued light treatment due to stinging and/or burning.

During light treatment, both patients and medical personnel should be provided with blue blocking protective eyewear, as specified in the BLU-U operating instructions to minimize ocular exposure.

Reimbursement and Insurance Coverage

Our DUSAdelivers team is committed to providing you with the most current private and federal reimbursement information for our products and to making the reimbursement process as smooth and efficient as possible. DUSA also provides personal consultation to help our valued customers navigate the reimbursement process.

Reimbursement support is available by phone, fax or e-mail. You can also use the " Request Personalized Support " form, which can be accessed through the menu to your left. No matter what avenue you choose, you can depend on a timely response from a member of our team.

The DUSAdelivers Team

DUSA Customer Service: (T) (F)

The Pinnacle Health Group, Inc.   (F)

Dusa@...

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Regional Providers….

You Searched For:

Zip=81621

Within 100 mile radius of Basalt, CO

3 Matches Found (displaying 1 to 3)

Name:

KATHA ROSSEIN MD

Address:

ASPEN CENTER FOR COSMETIC MEDICINE

Suite:

611 WEST MAIN STREET

City:

ASPEN

State:

CO

Zip:

81611

Telephone:

About:

15 miles

 

 

Name:

SANDRA EIVINS MD

Address:

DERM. CENTER OF STEAMBOAT SPR

Suite:

940 CENTRAL PARK DRIVE

City:

STEAMBOAT SPRINGS

State:

CO

Zip:

80487

Telephone:

About:

76 miles

 

 

Name:

THERESA A. SCHOLZ MD

Address:

ACCENT DERM & LASER INSTITUTE, PLLC

Suite:

1536 COLE BLVD; SUITE 120

City:

LAKEWOOD

State:

CO

Zip:

80401

Telephone:

About:

86 miles

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?CPT for Acne treatment with Blu-light

http://www.aad.org/members/publications/_doc/DCC_05_Spring.pdf

Photodynamic Therapy

Q. Our office is using aminolevulenic acid in conjunction

with a PDT light to treat acne. Can we use CPT

96567 to bill this service to an insurer?

 

A. CPT 96567 is used for photodynamic therapy which is

the external application of light to destroy lesions after

the application of photosensitive drug(s). The AMA

CPT descriptor of this code states that the procedure is

for destruction of premalignant and/or malignant

lesions. Submitting this code for any procedure other

than the destruction of a premalignant or malignant

lesion would be inaccurate. The claim would be

considered a false claim.

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Light options for acne…

 

http://www.docshop.com/education/dermatology/facial/blue-light/

 

Blue Light Therapy Systems

There are several blue light therapy systems available, and they all work by providing a specific frequency of light in order to target the bacteria that cause acne. Detailed below are the common light systems used for the treatment of acne: BLU-U®, ClearLight™, and Omnilux™.

BLU-U® System by Dusa

The BLU-U® Blue Light Photodynamic Therapy Illuminator system by DUSA Pharmaceuticals, Inc. gained FDA approval in 2003 for the treatment of mild to moderate acne. It is a compact light source with u-shaped fluorescent tubes designed to uniformly distribute blue light onto the treatment area. BLU-U® blue light system can be used alone as an acne treatment, or with Levulan® solution as part of blue light photodynamic acne therapy.

Lumenis ClearLight™ Phototherapy

The ClearLight™ Phototherapy system by Lumenis® was approved by the FDA in 2002 for use on moderate acne. It uses a high-intensity, narrow-band blue light to clear skin of acne by destroying bacteria. ClearLight™ may also be used for photodynamic acne therapy by applying Levulan® solution for several minutes before treatment with the blue light.

Omnilux blue™ and Omnilux revive™ Systems

Omnilux blue™ is similar to other blue light therapy systems; however, the system uses LEDs (light emitting diodes) instead of fluorescent tubes or bulbs. Omnilux blue™ can be used with Omnilux revive™, which emits red light, for a combination of blue light and red light therapy. During treatment, acne-causing bacteria are destroyed by the blue light, while the red light reduces inflammation and redness caused by acne lesions. Both systems are used alternately during treatment, and optimal results are typically achieved within four to eight weeks.

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http://www.dusapharma.com/levulan-pdt-procedures-coding-billing-guide.html

 

Levulan PDT Coding and Billing

COVERAGE

Medicare coverage is governed by National Coverage Determination (NCD) which is located at http://www.cms.hhs.gov/mcd/. Non-Medicare insurance coverage varies based on the patient's plan.

CODING

Diagnosis

The provider is required to report the most appropriate diagnosis code based upon the patient's condition and reason for treatment.

ICD-9-CM Coding

702.0

Actinic Keratoses (AK)

782.0

Pain of Skin (burning, prickling, numbness, tingling)

  

Levulan® Kerastick® Application

Report the appropriate HCPCS code for Levulan Kerastick. The units reported should equal the number of sticks utilized.

HCPCS Coding

J7308

Aminolevulinic acid HCl for topical administration, 20%, single unit dosage form (Levulan Kerastick)

 

BLU-U® Light Treatment

Report each PDT treatment session regardless of length or number of lesions treated.

CPT Coding

96567

Photodynamic therapy by external application of light to destroy premalignant and/or malignant lesions of the skin and adjacent mucosa by activation of photosensitive drug(s), each phototherapy exposure session

 

Evaluation and Management (E & M)

The appropriate E & M code reported is based upon patient history, patient examination, level of medical decision making, and dimensions of counseling.

When E & M services are required on the same date of service as PDT therapy, the use of a -25 modifier is required for the E & M visit. The E & M must be mapped to the appropriate diagnosis for the service on the claim. The modifier should always be reported in accordance with E & M and modifier guidelines.

CPT Coding

New Patient

Established Patient

99201

99211

99202

99212

99203

99213

99204

99214

99205

99215

Procedure coding should be based upon medical necessity and procedures and supplies provided to the patient. Coding and reimbursement information is provided for educational purposes and does not assure coverage of the specific item or service in a given case. DUSA Pharmaceuticals and The Pinnacle Health Group make no guarantee of coverage or reimbursement of fees. Contact your local Medicare Fiscal Intermediary, r or CMS for specific information that is subject to continuous change. To the extent that you submit cost information to Medicare, Medicaid or any other reimbursement program to support claims for services or items, you are obligated to accurately report the actual price paid for such items, including any subsequent adjustments. CPT five-digit numeric codes, descriptions, and numeric modifiers only are Copyright AMA.  All rights reserved. 

 

CODING AND BILLING GUIDE 

The information contained in this document is provided to assist health care facilities understand reimbursement guidelines and procedures. It is intended to help obtain accurate coverage and reimbursement for medically necessary health care services provided to patients under physician orders. It is not intended to increase or maximize reimbursement. Should you have questions regarding coding and reimbursement, please contact us at DUSA@....

The information referenced is based upon coding experience and research of current coding practices and published payer policies. They are based upon commonly used codes and procedures. The final decision for coding of any procedure must be made by the provider of care considering the medical necessity of the services and supplies provided, the regulations of insurance carriers and any local, state or federal laws that apply to the supplies and services rendered.

Although a particular service or supply may be considered medically necessary, the final coverage decision is based upon a review of the available clinical information and does not mean the service or supply will be covered by any payer. Each payer and benefit plan contains its own specific provisions for coverage and exclusions. Please consult individual payers to determine policy specific guidelines and whether there is any exclusion or other benefit limitations applicable to a particular service or supply.

 

======================================

http://www.trophyskin.com/index.php

 

Our Price: $199.00

 

 

Every order includes eye protection goggles to be worn during treatments. The BlueMD custom-made bulb emits light at 420 nm, which is outside the UV range. However, eye protection must still be worn. Each BlueMD device comes with a limited 1-year warranty covering any defects to the device or the bulb. Additional bulbs and goggles can be purchased upon request.

Top of Form

Bottom of Form

 

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http://findarticles.com/p/articles/mi_m0PDG/is_1_3/ai_113650109/pg_9/

Photodynamic therapy in dermatology: history and horizons

Journal of Drugs in Dermatology, Jan-Feb, 2004 by Amy Forman Taub

 

The ClearLight[TM] System (Lumenis), a narrow-band, high-intensity blue light (407-420 nm) has been FDA cleared for the treatment of moderate inflammatory acne (110). In a single-center open study (111), Kawada, et al. achieved 64% reduction in mild to moderate acne lesions when patients were treated with the ClearLight[TM] System twice weekly for up to 5 weeks. In a multicenter uncontrolled study, researchers achieved a 70% median reduction of inflammatory lesions in 175 patients with mild to severe acne (110).

======================

http://www.dusapharma.com/blu-u1.html

How Blue Light Treats Acne Vulgaris

In the treatment of acne vulgaris, 417 nanometer (nm) blue light activates endogenous photosensitizers within the P. acnes bacteria. This creates a toxic bacteriocidal environment in the sebaceous gland that inhibits the obstruction of the sebaceous follicle and formation of acne lesions.

 

 

====================================

BLU-U® Blue Light Photodynamic Therapy Illuminator Model 4170 Specifications

The BLU-U blue light photodynamic therapy illuminator is a compact light source comprised of 7 horizontally mounted U-shaped fluorescent tubes with a sheet metal chassis. The tubes are covered by a polycarbonate shield that directs cooling airflow within the unit and significantly minimizes the risk of glass-patient contact in the event of tube breakage. The BLU-U is mounted on a floor stand which provides 3-axis adjustment for rapid patient positioning.

Specifications:

• Weight: 155 lb

• Light source: Narrow band blue fluorescent tubes, continuous output

• Power requirements: 120 VAC, 2.5 Amp, 60 Hz

 

Dimensions of light unit and footprint of stand: 

• In Use Position: 

width: 36.5 inches

depth: 26.5 inches

height:  min 51.5 inches / max 66 inches

 

• Stored Position:                              

width: 24 inches

depth: 36 inches

height: 51.5 inches 

 

===========================

http://www.massacademyofdermatology.org/Presentations/photodynamic%20therapy.pdf

===========================

Joules don't equal watts--one's a measurement of energy, one's a mesurement of power.1 Watt = 1 Joule / 1 secEssentially, watts are how many joules you consume in a second.

============================

http://www.acnelamp.com/comparison.php

Acnelamp vs. Competitors

The best way to differentiate the Dima-Tech Acnelamp from its competitors is to demonstrate the effective output power of the light source.  The British Journal of Dermatology specified that the blue light between 405nm-420nm and red light between 655nm-665nm works best to reduce or even eliminate acne.  With this in mind, Dima-Tech Inc. developed the Acnelamp to be most powerful in these ranges.

[+/-] Table - Technical Specs

 

Acnelamp TabletopOrder Now

Acnelamp HandheldOrder Now

Acnelamp PenlightOrder Now

Dermastyle

Verilux 

Dichro-Acne Blue

Blue Intensity405-420nm

26273.0 uW/cm2

18620.0 uW/cm2

18340.0 uW/cm2

4868.9 uW/cm2

242.3 uW/cm2

366.0 uW/cm2

Red Intensity655-665nm

7841.7 uW/cm2

5074.0 uW/cm2

5046.3 uW/cm2

1630.9 uW/cm2

27.53 uW/cm2

None

Blue Peak Wavelength

415.20 nm

417.34 nm

417.77 nm

401.90 nm

435.78 nm

470.96 nm

Red Peak Wavelength

665.00 nm

657.54 nm

657.54 nm

666.97 nm

611.64 nm

None

Lights

70 LEDs per head

21 LEDs

1 LED

1 LED

2 Tubes

1 Flood Light

Cost

$249.99

$149.99

$39.99

$149

$189.95

$95.95

Blue Spectrum Graph

View Blue

View Blue

View Blue

View Blue

View Blue

View Blue

Red Spectrum Graph

View Red

View Red

View Red

View Red

View Red

None

[+/-] Comparison - Intensity of Blue Light 405nm-420nm (Per LED)

 

[+/-] Comparison - Intensity of Red Light 655nm-665nm (Per LED)

Summary

In the graphs above, the intensity of each light source is shown.  It is clear that the intensity of the Acnelamps is far greater than its competitors.  This is important because greater intensity allows light to penetrate deeper into the skin. All measurements were taken at the same distance, touching each light source, April 2006.

=======================

http://www.aetna.com/cpb/medical/data/600_699/0656.html

In an uncontrolled pilot study (n = 18), Taub (2004) examined the effectiveness of PDT-ALA in the treatment of moderate to severe inflammatory acne. ALA remained in contact with skin for 15 to 30 minutes before exposure to blue light (ClearLight [Lumenis] or BLU-U [Dusa Pharmaceuticals, Inc.]) or the Aurora DSR (Syneron Medical Ltd.), which uses Electro-Optical Synergy (ELOS), a unique combination of optical and radiofrequency (RF) energy. Patients received two to four ALA-PDT treatments over 4 to 8 weeks or two cycles of ALA-PDT (weeks 2, 4) preceded by salicylic acid peel (weeks 1, 3) over 4 weeks. The average follow-up time was four months. The author found that patients with moderate to severe acne can achieve durable improvement with short-contact ALA-PDT.