Ophthalmology and Optometry Coding Alert

Question: My physicians have started using Lucentis to treat wet macular degeneration. Would you tell me what codes I should use to bill for this service? West Virginia Subscriber Answer: There isn't a specific code for Lucentis (ranibizumab) yet. Genentech, the drug's manufacturer, recommends J3490 (Unclassified drugs) or J3590 (Unclassified biologics) for the drug supply. No NCD yet: Although Medicare has not yet established a national policy for coding ranibizumab, some Part B carriers (such as Palmetto GBA, West Virginia's Medicare carrier) have published local coverage determinations stating that you should use J3590. Palmetto GBA's LCD also instructs you to enter the name "Lucentis" or "ranibizumab," along with the dosage (such as 0.5 mg), in the narrative field of Item 19 on the CMS-1500 form or its electronic equivalent. Remember: You will also need to report 67028 (Intravitreal injection of a pharmacologic agent [separate procedure]) for the drug's injection. The U.S. Food and Drug Administration (FDA) approved ranibizumab on June 30, 2006, to treat neovascular (also known as "exudative" or "wet") age-related macular degeneration (AMD), in which abnormal blood vessels grow behind the macula. ICD-9 code 362.52 (Exudative senile macular degeneration) describes this condition and is the diagnosis code you should report for this treatment.