Wiki Intravitreal Injections and Office Visits

[BrendanMcAndrew]

Hi Folks!

Happy Monday to all my fellow coders out there.

I recently started working for a group of Retina specialists and I have a few questions.

The main question on my mind is billing office visits (92012, 99212, etc) with intravitreal injections (67028) on the same encounter.

Based on the information I have read and been told I understand that it is mostly frowned upon to bill for a visit when the patient receives and injection (especially if there are no new problems or changes). The problem is that many of our patients have long standing chronic conditions that do not change (macular degeneration, diabetic retinopathy).

The plan of care that is most often put in place is to bring the patient in monthly for an injection in one eye (switching eyes each visit). If the patient is being injected at every encounter and their conditions have remained stable when can we (if ever bill) for the exam. Surely we must submit for an exam at some point during the course of treatment, right?? Or are we just an injection factory (haha)?

Thanks in advance for your input and have an awesome day!

 

[michellereinarz]

You should use the nature of the appointment as a point of reference combined with documentation review. Meaning, if the patient is scheduled for the injection, even a low level ophthalmologist exam 92012 would not be appropriate. Unless, the patient presents with a complication or new onset of symptoms, there is an allowance for medical decision making built into the injection CPT code 67028. Typically, a complete exam takes place every 6 to 8 weeks during or at the end of a course of treatment.