Ophthalmology and Optometry Coding Alert

Question: Can you provide any advice about how many units of Lucentis^® to report when the ophthalmologist injects it?

Texas Subscriber

Answer: The answer will depend on how many milligrams of the drug the physician injected. To determine how many units of J2778 (Injection, ranibizumab, 0.1 mg) to report, always check the documentation — then calculate how many units of the drug that represents. For example, if you administer the standard Lucentis^® dose, 0.5 mg, report five units of J2778.

Keep a close eye on your accuracy for Lucentis^® coding. The OIG added Lucentis^® payments to its Work Plan last June.

“Medicare pays for an intravitreal injection (which is considered a minor surgery) as part of a global surgical package that includes the preoperative, intraoperative, and postoperative services routinely performed by the physician,” the OIG said at the time. “Separate payment can be made for other services provided by the same physician on the same day as the global surgery if the services are significant and separately identifiable or unrelated to the surgery. We will review claims for intravitreal injections of Eylea and/ or Lucentis and the other services billed on the same day as the injection, including evaluation and management services, to determine whether the services were reasonable and necessary and met Medicare requirements.”

Therefore, you should only report an E/M service with the Lucentis^® drug code and the injection procedure code (67028, Intravitreal injection of a pharmacologic agent (separate procedure)) if your notes clearly demonstrate a separately identifiable E/M service.