Ophthalmology and Optometry Coding Alert

Question: Our office just recently started doing injections for endophthalmitis. We have our local hospital pharmacy draw them for us, charging us. How do we charge a Medicare patient for the new patient consult, the actual injection (there are three total), the cost of the injections, and a tray fee?

Editors note: We are assuming the ophthalmologist was not the original operating surgeon. If the original surgeon were treating a complication of surgery that did not require returning the patient to the operating room, that would mean the service was included in the global surgery package for follow-up care.

Elaine Detter, Bookkeeper
Retinal Diagnostic Center
Campbell, Calif.

Answer: The medications being injected for endophthalmitis, a severe eye infection, are vancomycin, amikacin, and ceftazidin antibiotics. Detter tells us that the hospital is charging her practice $190 for each medication, and that three separate administrations are required.

The best way to bill for the medications is to use the J codes: however, there is only a J code for vancomycin (J3370 for up to 500 milligrams). There is no J code for amikacin or ceftazidin, but the HCPCS system has a code for unclassified drugs: J3490. Since there are three medications done in three separate injections, you can bill for three codes.

Also, if endophthalmitis is being treated, these are most likely posterior segment injections into the vitreous body, which would be 67028. Because an unclassified drug code must be used, it would be best to submit this claim on paper with the hospital invoices attached for the drug costs.

A cover letter should be attached that explains the three separate injections and the medical necessity for the three different drugs. You can also charge the code for a consultation (99241-99245). Note that it doesnt matter for an office or other outpatient consultation whether the patient is new or established. Medicare will not pay you for the tray.