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CAN I BILL 92014 WITH 67028 ON SAME DAY?

Lisa Posted Thu 31st of October, 2013 10:59:44 AM

CAN I BILL 92014 WITH 67028 ON SAME DAY WHEN A PATIENT IS RETURNING FOR THEIR MONTHLY INJECTION OF LUCENTIS FOR WET MACULAR DEGENERATION?

SuperCoder Answered Thu 31st of October, 2013 16:15:13 PM

Several issues exist here:

1. Make sure documentation supports the medical necessity for a comprehensive exam the same day as injections. The exam must be significantly, separately identifiable from the exam performed the same day as the injection. If the exam is performed solely to confirm the need to inject, it is NOT separately billable.

2. Do NOT append modifier –59; it should never be appended to an exam. By appending modifier –59, you may erroneously override the bundling edit. This practice may subject you to a future Recovery Audit Contractor audit.

3. As with recent, medically unlikely edits, bilateral drug injections should be submitted as 67028–50. Otherwise, the claims will be denied. Double your charge. Payment will be 150 percent of the allowable — just as when billing with –RT/–LT.

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