EyeNet Magazine



   
 
Savvy Coder: Coding & Reimbursement
Take the Sting Out of Injection Coding
By Sue Vicchrilli, COT, OCS, Academy Coding Executive
 
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(PDF 135 KB)

Trying to find the right code for an injection can be frustrating because they are not all in the same section of CPT 2012, the AMA’s reference book. To make your billing easier, here are seven of the more frequently used injection codes.

Seven CPT Codes for Injections

11900 Injection, intralesional; up to and including seven lesions

Global period: Zero days.
Typical allowable: $56 in the office and $32 in a facility.

CODING TIPS: Payment is per eye. CPT code 11900 is often used for an injection of medication to prevent recurrent chalazia. Another situation in which this code can be used is for an intralesional steroid injection on the lid for such conditions as hemangioma.

64612 Chemodenervation of muscles(s); muscle(s) innervated by facial nerve (e.g., for blepharospasm, hemifacial spasm)

Global period: 10 days.
Typical allowable: $173 in the office and $158 in a facility.

CODING TIPS: For Medicare Part B, payment is 100 percent of the allowable for one side of the body (e.g., the right) and 50 percent of the allowable for the other side (e.g., the left), regardless of the number of injection sites. Payment for commercial payers varies. With proper documentation, some insurers pay per injection site, while others pay per session, regardless of the number of injection sites.

66020 Injection, anterior chamber of eye (separate procedure); air or liquid

66030    ; medication

Global period: 10 days.
Typical allowable: For 66020, $181 in the office and $127 in a facility; for 66030, $164 and $110.

CODING TIP: Payment is per eye. Use for postoperative repair of a flat anterior chamber.

67028 Intravitreal injection of a pharmacologic agent (separate procedure)

Global period: Zero days.
Typical allowable: $116 in the office and $104 in a facility.

CODING TIP: Payment is per eye.

67345 Chemodenervation of extraocular muscle

Global period: 10 days.
Typical allowable: $244 in the office and $220 in a facility.

CODING TIP: Payment is per eye.

68200 Subconjunctival injection

Global period: Zero days.
Typical allowable: $42 in the office and $35 in a facility.

CODING TIP: Payment is per eye. It is not appropriate to code this prior to an intravitreal injection.

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Coding for Injectable Drugs

If a single-dose vial, bill for the entire vial: either 1) submit one line item for the number of units injected and a second line item for the wastage, appended with modifier -JW; or 2) submit one line item for the entire vial units and indicate in box 19 how many units were wasted. If a multiuse vial, bill only for the units injected.

Go to Coding Tools at www.aao.org/coding for HCPCS and NDC codes, as well as coverage policies for Avastin, Macugen, and Lucentis.

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Three FAQs

Q: When an exam is performed the same day as an injection (not in a global period), is it OK to always submit the appropriate level of exam appended with modifier –25? 
A: It depends. See the October 2010 Savvy Coder.

Q: Should you be paid for injections  given during the global period?
A: Yes. Append modifier –58 to the injection code. Bill the drug, too.

Q: Should we bill separately for drugs to numb the skin or tissue?
A: Injections used to numb the eye are never separately billable.

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