Wiki 67028 Help - billed twice on the same DOS for the same eye

aruffolo

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I have a couple claims where we have injected both Ozurdex & Avastin into the same eye on the same date of service. Our coders billed it as 67028-LT & 67028-76-LT, but the claims have been denied by Medicare for MUE.

Since Avastin is a standard liquid injection and Ozurdex is a solid implant requiring a proprietary implantation device, it seems as though we should be able to bill this code twice as there are two separate injections, but Medicare has still denied the claims after the redetermination I submitted explained this fact.

Have any of you had any success with billing this code twice on the same eye or can it simply not be done at all?
 
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Looking at the CPT book, 67028 can only be reported once during a defined treatment period, regardless of the number of sessions.
 
Yeah, that's what I thought, but I wasn't sure if anyone else had any success with getting two line items to pay. We gave up :)

Thanks!
 
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