Ophthalmology and Optometry Coding Alert

Question: An article regarding Avastin in the September 2006 Ophthalmology Coding Alert states that bevacizumab has its own HCPCS code (J9035), which specifies a 10-mg dose and may not be appropriate for a smaller dose. Our group of ophthalmologists uses Avastin to treat wet macular degeneration. We do use the 10 mg, so should we be using J9035 for billing?

Minnesota Subscriber

 Answer: You-ll need to check with your individual carriers to see which HCPCS code they will accept when you-re reporting Avastin use for treating wet macular degeneration (362.52, Exudative senile macular degeneration).

     
As the September article states, bevacizumab (Avastin) does have its own HCPCS code: J9035 (Injection, bevacizumab, 10 mg). Because your ophthalmologist administers the 10-mg dosage, you don't have to worry about reporting an amount other than the amount specified in the code descriptor. But your carrier may still not accept J9035 when an ophthalmologist uses Avastin for macular degeneration treatment because the FDA originally approved the drug to treat colon cancer and only approved it for wet macular degeneration treatment in June 2006.

     
Alternative: Some carriers direct you to report J3490 (Unclassified drugs), and still others want providers to use J3590 (Unclassified biologics).