Ophthalmology and Optometry Coding Alert

"Question: What is the correct way to code for a Kenalog-40 injection?

Anonymous Pennsylvania Subscriber

Answer: It depends on what the injection is being given for because that usually determines the location for the injection to be given. If its for uveitis, you would probably use 67500* (retrobulbar injection; medication [separate procedure, does not include supply of medication]). If for cystoid macular edema, you would probably use 67515* (injection of therapeutic agent into Tenons capsule).

If for a stubborn chalazion, you would probably use 90782 (therapeutic of diagnostic injection; subcutaneous or intramuscular) because that injection is typically located under the surface of the skin (i.e., subcutaneous). In all cases, you would also bill the HCPCS code for the Kenalog itself: J3301 (injection, triamcinolone acetonide, per 10 mg). This HCPCS code applies to Kenalog-10, Kenalog-40, Tri-Kort, Kenaject-40, Cenacort A-40, Triam-A and Trilog. Note that 67500 and 67515 are starred procedures, which means that you can bill an office visit too. (Nobody walks into your office and says, Give me a Kenalog injection. The ophthalmologist must do the exam and make the decision about therapy.)

CPT states that starred procedures cover only the procedure itself, with no pre- or post-operative care. Also, new in 2000, you must use modifier -25 (significant, separately identifiable evaluation and management service by the same physician on the same day of the procedure or other service) on the office visit: When the starred procedure is carried out at the time of an initial or established patient visit involving significant identifiable services, the appropriate visit is listed with the modifier -25 appended in addition to the starred procedure and its follow-up care.

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