Wiki 67210 & 67028 same day

[pataw514]

I have a retinal specialist that performed a focal laser for diabetic retinopathy and also did an intravitreous injection for macular edema on the same day. BS is denying the injection as being included in the surgery. I do not see the two codes on the NCCI edits.. .
Any ideas?
Thanks in advance for any advise.
Pat White, CPC

 

[dkeown]

I have a retinal specialist that performed a focal laser for diabetic retinopathy and also did an intravitreous injection for macular edema on the same day. BS is denying the injection as being included in the surgery. I do not see the two codes on the NCCI edits.. .
Any ideas?
Thanks in advance for any advise.
Pat White, CPC

Wonder if it's because both procedures indicate an injection is performed, even though not for the same reason? By chance did you append a -59 modifier to 67028? Not saying BS will recognize the modifier, but according to the current Coding Companion for Ophthalmology, this is needed.

Hope this helps!
David Keown, CPC, OCS

 

[rhotonscott]

Normally you cannot bill for Avastin with PRP due to some opthalmologists do a subconjunctival injection of anesthetic prior to performing PRP, which is the same way Avastin is injected.(per Encoder Pro). My feeling is if you have a different diagnosis, like retinal edema for the Avastin AND the optho doc can document that tha avastin injection WAS actually a separate prcedure requiring additional work THEN you may be able to unbundle the injection with a -59 modifier, but your insurance carrier will still probably deny it!!! If it is a differenrt eye, however use you RT/LT modifiers and you CAN get reimbusement. This is all conjecture however based on less than a year of Ophthalmology coding...