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Can you bill for injection and exam on same day?

Angela I Posted Wed 17th of October, 2018 11:09:00 AM
Greetings, I've been asked if I can bill for injection (67028) and exam and get paid for each separately. My understanding is that the exam is included in the injection payment unless a separate, new Dx is discovered that warrants an exam. Can anyone clarify this for me please? Thank you.
SuperCoder Answered Thu 18th of October, 2018 06:31:11 AM

Hi Angela,

Thank you for your question.

The documentation of the procedure and the documentation of the significant, separately identifiable service must be clearly separate and distinct in the medical record to fulfill the requirements of “separately identifiable.” If both services are mixed together in a single visit without any separation to identify the separate and distinct nature of the services, then the requirement for a “separately identifiable” service has not been met.

As per the above scenario it seems 67028 (Intravitreal injection of a pharmacologic agent [separate procedure]) appropriate to bill for this service as sometimes provider after administration of intravitreal injection perform the examination. If the examination is for separate reason and documentation clearly states separately identifiable service was performed, then only you can bill for that service with appropriate service code.

Hope this helps!

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