Ophthalmology and Optometry Coding Alert
How Many Lucentis Units Should You Report?
Question: We just administered Lucentis injections for the first time, and it was very expensive, so we want to make sure we’re reporting it accurately. Which codes and how many units should we bill? Florida Subscriber Answer: When you report Lucentis injections using the indicated single dose, 0.5 mg, you should report five units of J2778 (Injection, ranibizumab, 0.1 mg). On the same claim, report 67028 (Intravitreal injection of a pharmacologic agent (separate procedure)) for the injection of the drug. Most insurers will accept a code from the H35.32xx (Exudative age-related macular degeneration) series to prove medical necessity for an intravitreal Lucentis injection. If your provider injects both eyes, report 67028 with modifier 50 (Bilateral procedure) or with modifiers LT (Left side) and RT (Right side). In addition, don’t forget to calculate how many units of the drug you should bill, since it may be higher than the standard 0.5 mg dose. Therefore, if you inject 0.5 mg of Lucentis into the patient’s left eye to treat exudative age-related macular degeneration, you’d report 67028-LT, J2778 x 5, and H35.3220 (Exudative age-related macular degeneration, left eye, stage unspecified).
Related Articles
Ophthalmology and Optometry Coding Alert
- Compliance:
Avoid Making the Mistakes These Optometrists Made
CMS says optometrists logged startling 84 percent DME error rate. Eye care coders have to [...] - Check out CMS’ Review Benchmarks
CMS identified a total of $25.74 billion in total improper payments among providers sampled in [...] - Part B Coding:
Check These 4 Essential FAQ Answers for Clean Eye Care Coding
Part B reps answered several burning questions during a recent session. Are you vexed by [...] - Modifier Clip And Save:
Nail Down Your Bilateral Billing Rules With This Guide
Bilateral procedures are common in ophthalmology practices, since medical issues often affect both eyes. While [...] - Reader Questions:
Is Modifier 51 Required?
Question: We have a coder who puts modifier 51 (Multiple procedures) on almost all surgical [...] - Reader Questions:
Keep Medical Necessity at Top of Mind for Baseline Images
Question: An ophthalmologist in our practice would like to offer baseline photos, taken with his [...] - Reader Questions:
Look to 65210 for Conjunctival Concretion Removal
Question: Can you help me determine the right code for removing conjunctival concretions? The ophthalmologist [...] - You Be the Coder:
How Many Lucentis Units Should You Report?
Question: We just administered Lucentis injections for the first time, and it was very expensive, [...]
