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Photochemotherapy, specifically psoralens and ultraviolet A (PUVA), is a therapeutic procedure utilized to treat various severe photoresponsive dermatoses. This includes conditions such as psoriasis, eczema, vitiligo, and mycosis fungoides, which are skin disorders that respond positively to light therapy. The treatment involves the administration of psoralen, a medication that enhances the skin's sensitivity to UVA light, taken orally approximately two hours prior to exposure to the ultraviolet light. This preparatory step is crucial as it maximizes the effectiveness of the subsequent light therapy. In addition to PUVA, other forms of photochemotherapy, such as Goeckerman therapy, which combines coal tar and UVB light, or the use of petrolatum with UVB light, are also employed for similar conditions. After the psoralen is ingested or the topical agents like coal tar or petrolatum are applied, the patient is positioned in a specialized UVA or UVB light booth for a predetermined duration, tailored to the specific dermatosis being treated. The exposure time is critical and varies based on the individual condition and its severity. Post-treatment, any topical medications are carefully removed from the skin, followed by a thorough inspection of the treated areas, and dressings are applied as necessary to ensure proper healing and protection of the skin.
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The procedure of photochemotherapy using psoralens and ultraviolet A (PUVA) is indicated for the treatment of several severe photoresponsive dermatoses. These include:
The procedure for photochemotherapy using PUVA involves several key steps that ensure the effective treatment of the indicated dermatoses.
After the completion of the PUVA therapy, patients are typically monitored for any immediate reactions to the treatment. It is important to inspect the skin for any signs of irritation or adverse effects. Patients may be advised on post-treatment care, which could include avoiding sun exposure for a certain period and following specific skincare routines to support healing. The frequency and duration of follow-up treatments will depend on the individual’s response to therapy and the specific dermatosis being treated.
| Short Descr | PHOTOCHEMOTHERAPY PUVA | Medium Descr | PHOTOCHEMOTX PSORALENS&ULTRAVIOLET A PUVA | Long Descr | Photochemotherapy; psoralens and ultraviolet A (PUVA) | 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) | P5A - Ambulatory procedures - skin | 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. | XU | Unusual non-overlapping service, the use of a service that is distinct because it does not overlap usual components of the main 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. | 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.) | 95 | Synchronous telemedicine service rendered via a real-time interactive audio and video telecommunications system: synchronous telemedicine service is defined as a real-time interaction between a physician or other qualified health care professional and a patient who is located at a distant site from the physician or other qualified health care professional. the totality of the communication of information exchanged between the physician or other qualified health care professional and the patient during the course of the synchronous telemedicine service must be of an amount and nature that would be sufficient to meet the key components and/or requirements of the same service when rendered via a face-to-face interaction. modifier 95 may only be appended to the services listed in appendix p. appendix p is the list of cpt codes for services that are typically performed face-to-face, but may be rendered via a real-time (synchronous) interactive audio and video telecommunications system. | 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 | XS | Separate structure, a service that is distinct because it was performed on a separate organ/structure |
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| 2025-01-01 | Changed | Short and Medium Descriptions changed. |
| Pre-1990 | Added | Code added. |
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