Wiki Can codes 92014-25 and 67028 be billed on the same visit

[Rschre2]

I have a question regarding the billing of CPT 92014/25 with 67028. Patient returns for monthly Left eye injection. Both eyes are examined. Left eye is injected and documentation states right eye is stable. Does the examination of the eye not being injected count as a separate and distinct service? Also does a complete eye exam include looking at both eyes or is each eye considered a separate exam? Is the exam of both eyes included in the preoperative care for the injection of only one eye? Any guidance or information that gives further details regarding how these codes should be billed would be appreciated.

 

[Cheezum51]

Exam for both eyes, or only one eye, would be covered under the same 92*** code. You couldn't bill one 92*** for examining one eye and a separate 92*** code for the eye that's going to be injected.

The level of 92*** code you use of course depends on the extent of the history, exam and level of decision making you have in the exam. I would imagine that the level of decision making for an eye that's being injected would be at least moderate and perhaps even of high complexity due to the risk to ocular health.

 

[mzkandyd]

Based off the documentation your provided, the E/M wouldn't be separately reimbursable because the reason or the visit was for the injection. If the reason was for CC and then the decision for the inject was made, then I would say, bill the E/M and add the 25 modifier.