MAR 12, 2019
New Diagnosis Prompting Another Injection Less than 28 Days
Question: I treated a patient with Eylea in the right eye for diabetic macular edema. Two weeks later she developed a retinal vein occlusion with macular edema in the same eye, so I injected Lucentis. Since there is a new diagnosis and the drug has been changed, will the fact that she received two injections in the same eye less than 28 days apart be problematic?
Answer: Most LCD policies state that they do not expect to see a drug change sooner than 28 days. If you receive a denial for the second injection, appeal with your documentation of medical necessity. You may request a peer-to-peer review. For the Medicare Part B beneficiary it is best to have an ABN on file for the second injection and append the -GA modifier.
Learn more about injections in the Complete Guide to Retina Coding.