Results 1 to 2 of 2

OV and Injection, Modifier 25?

  1. #1
    Question OV and Injection, Modifier 25?
    Exam Training Packages
    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?

  2. #2
    Lexington Kentucky Chapter
    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.)

Similar Threads

  1. Replies: 2
    Last Post: 09-18-2015, 01:17 PM
  2. Use of Modifier 59 with an injection and hydration
    By bquestell in forum Modifiers
    Replies: 2
    Last Post: 04-13-2015, 09:14 AM
  3. ov with modifier 25 and injection
    By Bonnie Owen in forum Modifiers
    Replies: 34
    Last Post: 05-29-2013, 03:01 PM
  4. Modifier needed for injection?
    By kjdallas in forum Modifiers
    Replies: 4
    Last Post: 10-26-2011, 03:57 PM

Posting Permissions

  • You may not post new threads
  • You may not post replies
  • You may not post attachments
  • You may not edit your posts
Enjoying Our Forums?

AAPC forums are a benefit of membership. Joining AAPC grants you unlimited access, allowing you to post questions and participate with our community of over 150,000 professionals.

Join Now Continue Reading Without Full Access

Already a Member?


Close Message

In addition to full participation on AAPC forums, as a member you will be able to:

  • Access to the largest healthcare job database in the world.
  • Join over 150,000 members of the healthcare network in the world.
  • Be a part of an industry leading organization that drives the business side of healthcare.
  • Save anywhere from 10%-50% with exclusive member discounts on courses, books, study materials, and conferences.
  • Access to discounts at hundreds of restaurants, travel destinations, retail stores, and service providers. AAPC members also have opportunities to save on heath, life, and liability insurance.
  • Become a member of a local chapter and attend regular meetings.

Get OurFREE2017SalarySurvey.

We'll email you a link to our 2017 Healthcare Salary Survey when it is available so you can see your earning potential.