Ophthalmology and Optometry Coding Alert

Bill Q3013 for Visudyne

Medicare has instructed carriers to accept HCPCS code Q3013 (this is a new code, not listed in HCPCS 2001) for Visudyne (verteporfin), the medication use in photodynamic therapy, when the treatment is coded 67221 (destruction of localized lesion of choroid [eg, choriidal neovasularization]; photodynamic therapy [includes intravenous infusion]). Effective July 1, carriers must accept Q3013 when billed with exudative senile macular degeneration (362.52), according to Medicare memorandum transmittal AB-01-37. 
The program memorandum also orders that claims for 67221 must be denied when billed with 362.51 (nonexudative senile macular degeneration) or 362.50 (macular degeneration [senile], unspecified). 
Medicare is not requiring a fluorescein angiogram (FA) with each claim. The program memorandum specifies, however, that carriers may require you to maintain the FA in the patient's file for audit purposes.
You’ve reached your limit of free articles. Already a subscriber? Log in.
Not a subscriber? Subscribe today to continue reading this article. Plus, you’ll get:
  • Simple explanations of current healthcare regulations and payer programs
  • Real-world reporting scenarios solved by our expert coders
  • Industry news, such as MAC and RAC activities, the OIG Work Plan, and CERT reports
  • Instant access to every article ever published in Revenue Cycle Insider
  • 6 annual AAPC-approved CEUs
  • The latest updates for CPT®, ICD-10-CM, HCPCS Level II, NCCI edits, modifiers, compliance, technology, practice management, and more