Ophthalmology and Optometry Coding Alert

Question: When billing for endophthalmitis patients, my doctor reports 65800 for paracentesis anterior chamber tap and 67028 x 3 due to using Vancomycin, Amikacin, and Decadron all in separate syringes and therefore three separate shots. Our local carrier is only allowing for one unit on 67028. Please tell me the proper way to handle this situation.

Mississippi Subscriber

Answer: The appropriate CPT code to report for the injections is 67028 (Intravitreal injection of a pharmacologic agent [separate procedure]) times three  units. You should appeal the claim to the carrier and provide a written explanation as to why three different medications were medically necessary in treating the endophthalmitis for this patient. Send this explanation along with a copy of the medical record notes, the denial and CMS-1500 claim form asking for a review of the charges for payment.