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Ophthalmology and Optometry Coding Alert

3 Guidelines Untangle AMD Drug Supply Knot

Published on Wed Jun 17, 2009

With up to $2,191 at stake, knowing your payer's rules is critical. Sticking to your carriers' preferred HCPCS code for reporting Lucentis, Avastin, and Macugen can net your practice from $50 to almost $2,200. Earlier, Ophthalmology Coding Alert explained the use of 67028 (Intravitreal injection of a pharmacologic agent [separate procedure]) to report the drug injections ophthalmologists can use to treat age-related macular degeneration (AMD) ("Don't Let AMD Reimbursement Fade Away," Volume 12, Number 5). Here's how to keep AMD injection supply codes straight for three of the often-used drugs: • bevacizumab (trade name Avastin) • ranibizumab (trade name Lucentis) • pegaptanib sodium (trade name Macugen). Stick With J2778 for Lucentis To treat AMD, patients may receive an average of five to seven 0.5 mg injections per year of Lucentis. This drug is an anti-vascular endothelial growth factor (VEGF) agent that controls the growth and leakage of abnormal new blood [...]
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