Ophthalmology and Optometry Coding Alert

Question: What is the proper coding for an intra-vitreal injection of Avastin at the end of a vitrectomy with panretinal photocoagulation?

Maryland Subscriber

Answer: You should report 67028 (Intravitreal injection of a pharmacologic agent [separate pro-cedure]) and J3590 (Unclassified biologics) in addition to the proper code for the vitrectomy. You should list the name of the drug and the dosage in box 19 on the CMS-1500 form.

Don't miss: The Correct Coding Initiative (CCI) bundles 67028 with many vitrectomy codes, including 67039 (Vitrectomy, mechanical, pars plana approach; with focal endolaser photocoagulation) and 67040 (Vitrectomy, mechanical, pars plana approach; with endolaser panretinal photocoagulation). But in this case, your ophthalmologist is injecting the Avastin as a separate treatment that is not integral to the surgery. Therefore, you should append modifier 59 (Distinct procedural service) to the column 2 bundled service -- in this case, 67028 -- to break the bundle between the two codes.

Note: There is another HCPCS code for Avastin, but oncology coders use that code, not ophthalmology.