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Ophthalmology and Optometry Coding Alert

Reader Questions:

Code Intravitreal, Not Intravenous, for PDT

Published on Sat Mar 12, 2005


Question: For triamcinolone injections followed by PDT, is it correct to code 67028 (instead of 90780) along with the drug supply for Visudyne?


North Carolina Subscriber
Answer: Yes. Code 67028 (Intravitreal injection of a pharmacologic agent [separate procedure]) covers the injection of triamcinolone into the vitreous prior to photodynamic therapy (PDT). The CPT code for PDT, 67221 (Destruction of localized lesion of choroid [e.g., choroidal neovascularization]; photodynamic therapy [includes intravenous infusion]) includes the intravenous infusion of Visudyne, so you cannot report 90780 (Intravenous infusion for therapy/diagnosis, administered by physician or under direct supervision of physician; up to one hour) separately.
 
Although NCCI deleted its 67221/90780 bundle at the end of 2004, most carriers still state that they will not pay for both procedures.

For the supply of Visudyne, report HCPCS code J3396 (Injection, verteporfin, 0.1 mg).
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