Ophthalmology and Optometry Coding Alert

Question: Can you explain how to bill for triamcinolone acetonide when given as a bilateral intravitreal injection? The physician administered 2 mg and the drug came from a 40 mg multidose vial.

AAPC Forum Participant

Answer: When billing for injectable drugs, you should use a J code to identify the medication used and report how many units of the drug the physician administered. The correct HCPCS Level II code for Kenalog is J3301 (Injection, triamcinolone acetonide, not otherwise specified, 10 mg). Note the descriptor indicates the minimum dosage and single unit is 10 mg. In cases such as this, where the dosage is less than one unit, you’ll round up to the nearest unit.

Tip: Be sure to check the physician’s documentation to verify all the injection details including vial type. If a drug’s packaging indicates that the vial is multidose, you will bill based on the amount of drug administered to the patient. If the provider uses a single-dose vial, reimbursement is based on the amount of drug in the vial, so you must also account for wastage.

Because your physician injected 2 mg of Kenalog from a multidose vial, you won’t need any modifiers — only bill for the dose administered:

• J3301, 1 unit x 1.083 = $1.08
• Total reimbursement = $1.08

Confirm that the documentation clearly states the dose injected and that it is accurately reflected on the claim submission.

Make sure to report the appropriate National Drug Code (NDC) for the medication, as well. The NDC can be identified on the vial or confirmed in the NDC directory at www.accessdata.fda.gov/scripts/cder/ndc/index.cfm.

To reflect the intravitreal drug administration, use 67028 (Intravitreal injection of a pharmacologic agent (separate procedure)) with modifier 50 (Bilateral procedure).