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Wiki OV and Injection, Modifier 25?

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donna2hottie

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After speaking to a highranking employee at Medicare, one of our doctors was told that you should ALWAYS bill an office visit with an injection for Avastin/Kenalog/Lucentis. He was told that Medicare decreased the payment for 67028 because an office visit should be billed in addition to the injection and drug. The billing/coding/compliance staff disagrees. The pt presents for a "possible" injection every 4-6 weeks. The doctor does a slit lamp exam, interperts the OCT and determines if an injection will be done. The problem is not a new problem, and we do not feel that the evaluation is "above and beyond" what is typically expected as part of the pre-eval for the injection. Thoughts?
 
As a "possible" procedure, I would agree with Medicare on this one, since you wouldn't avoid billing the patient if no injection was performed (as long as the physician's documentation supports and a modifier -25 appended to the OV.)
 
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