Wiki intravitreal injection just curious

[terrij38]

Pt has cataract removed and physician does intravitreal injection of kenalog and this is co-managed with another physician. How would you code? Just curious. Thanks

TJ

 

[vpcats]

Pt has cataract removed and physician does intravitreal injection of kenalog and this is co-managed with another physician. How would you code? Just curious. Thanks

TJ

Was the intravitreal injection at the same time/session as the cataract extraction? If so, I believe the IVI is bundled and not separately billable. The facility can bill the supply of medication.

Who is MD co-managing with? Optometrist? And what is being co-managed? The post-op period? There are specific co-management rules. You can access that info on line (Google) or the CMS manual too, or PM me.

 

[terrij38]

Intravitreal inj

Intravitreal injection is not bundled with 66984 and correct the Facility bills for the medication. Co management is for Cataract Surgery. The intravitreal injection is same session as cataract surgery usually given to diabetic with retinal edema or other disorder. I was curious as to how some offices bill the intravitreal injection at the time of cataract surgery or other procedure.

I know some use the 59 modifier with the mulitple procedure modifier of 51. Curious though if some use the 54 modifier as well depicting co manage as the 51 and 54 are paying modifiers.

Thanks for all in put.
TJ

 

[vpcats]

Intravitreal injection is not bundled with 66984 and correct the Facility bills for the medication. Co management is for Cataract Surgery. The intravitreal injection is same session as cataract surgery usually given to diabetic with retinal edema or other disorder. I was curious as to how some offices bill the intravitreal injection at the time of cataract surgery or other procedure.

I know some use the 59 modifier with the mulitple procedure modifier of 51. Curious though if some use the 54 modifier as well depicting co manage as the 51 and 54 are paying modifiers.

Thanks for all in put.
TJ

If the 67028 is not bundled with the 66984, then you wouldn't need the 59 modifier.
You can use the 51 to denote secondary procedure but not really mandated anymore. I would use it anyway though.
Yes, you need the 54 if the surgeon is not providing all the post-op care, and use from to dates. The other doctor who will, needs to use the same surgery code, use modifier 55 on his claim and list from to dates also (when he picks up patient and finishes).

There needs to be a formal, written agreement between surgeon, optom and patient regarding transfer of care.

 

[rhotonscott]

As far as I know, intravitreal injections CPT67028 are not part of CE unbundles and can be coded separately, making sure to bill for the actual physician doing the injection and following all other facility policies and proper coding rules.