How To Use CPT Code 67028

CPT 67028 is a code for intravitreal injection of a pharmacologic agent as a separate procedure. This article will cover the description, procedure, qualifying circumstances, appropriate usage, documentation requirements, billing guidelines, historical information, similar codes, and examples of CPT 67028.

1. What is CPT 67028?

CPT 67028 is a medical billing code used to describe the intravitreal injection of a pharmacologic agent as a separate procedure. This code is used by medical coders and billers to report the specific procedure performed by an ophthalmologist or other qualified healthcare provider. The procedure involves injecting a medication into the vitreous chamber of the eye, either as an isolated procedure or a separate procedure unrelated to any other procedure being performed on the eye.

2. 67028 CPT code description

The official description of CPT code 67028 is: “Intravitreal injection of a pharmacologic agent (separate procedure)”.

3. Procedure

The 67028 CPT code procedure involves the following steps:

1. The ophthalmologist sterilizes the injection site and checks the intraocular pressure along with papillary dilation.
2. Topical anesthesia is applied to the eye.
3. The intravitreal agent is drawn into a syringe, ensuring no air bubbles remain.
4. The needle is introduced into the middle of the vitreous cavity, aiming posterior and slightly inferior.
5. The drug is administered slowly into the eye.
6. After administration, the needle is removed slowly.
7. If necessary, indirect ophthalmoscopy is performed to ensure the correct placement of the medication.
8. Finally, antibiotics are applied, and the patient is transferred to a recovery room.

4. Qualifying circumstances

Patients eligible to receive CPT code 67028 services are those diagnosed with conditions such as macular degeneration, diabetic retinopathy, retinal vein occlusion, or other diseases of the retina and eye that require intravitreal injections of pharmacologic agents for treatment. The healthcare provider must determine that the intravitreal injection is medically necessary and appropriate for the patient’s condition.

5. When to use CPT code 67028

It is appropriate to bill the 67028 CPT code when the provider performs an intravitreal injection of a pharmacologic agent as a separate procedure, unrelated to any other procedure being performed on the eye. The code should not be reported when the injection is performed along with a related procedure (e.g., same anatomic area or through the same incision, orifice, or surgical approach). If the provider performs this procedure with an unrelated procedure, append modifier 59, Distinct procedural service, to the code. Be sure the documentation supports the procedure as a separate procedure and not part of some other related procedure.

6. Documentation requirements

To support a claim for CPT 67028, the healthcare provider must document the following information:

• Patient’s medical history and diagnosis requiring intravitreal injection
• Details of the pharmacologic agent used, including dosage and lot number
• Specific eye and injection site
• Procedure steps, including anesthesia, needle insertion, drug administration, and post-procedure care
• Any complications or adverse reactions encountered during the procedure
• Follow-up care instructions and planned monitoring of the patient’s condition

7. Billing guidelines

When billing for CPT code 67028, it is essential to follow the appropriate guidelines and rules. Do not append modifier 59 when a more specific modifier, such as XE (same date, separate encounter), XP (different practitioner), XS (separate organ or structure), or XU (service does not overlap with the usual components of the main service), is applicable. Documentation must support the use of the modifier. Do not confuse modifier 59 with modifier 51 for multiple procedures (e.g., same procedure on different anatomic sites, related procedures on the same anatomic site, or the same procedure multiple times on the same anatomic site).

8. Historical information

CPT 67028 was added to the Current Procedural Terminology system on January 1, 1991. There have been no updates to the code since its addition.

9. Similar codes to CPT 67028

Five similar codes to CPT 67028 and how they differentiate from CPT 67028 are:

• CPT 67025: Injection of vitreous substitute, fluid-gas exchange, or air; this code is used for the injection of a vitreous substitute, not a pharmacologic agent.
• CPT 67027: Implantation of intravitreal drug delivery system; this code is used for the implantation of a drug delivery system, not a single injection of a pharmacologic agent.
• CPT 67030: Severing of vitreous strands; this code is used for the severing of vitreous strands, not an intravitreal injection.
• CPT 67031: Laser surgery for the treatment of a retinal tear or detachment; this code is used for laser surgery, not an intravitreal injection.
• CPT 67036: Removal of the vitreous; this code is used for the removal of the vitreous, not an intravitreal injection.

10. Examples

Here are 10 detailed examples of CPT code 67028 procedures:

1. A patient with wet age-related macular degeneration receives an intravitreal injection of an anti-vascular endothelial growth factor (anti-VEGF) agent in the right eye.
2. A patient with diabetic macular edema undergoes an intravitreal injection of a corticosteroid in the left eye.
3. A patient with retinal vein occlusion receives an intravitreal injection of an anti-VEGF agent in the right eye.
4. A patient with uveitis undergoes an intravitreal injection of a corticosteroid in the left eye.
5. A patient with choroidal neovascularization receives an intravitreal injection of an anti-VEGF agent in the right eye.
6. A patient with cystoid macular edema undergoes an intravitreal injection of a corticosteroid in the left eye.
7. A patient with proliferative diabetic retinopathy receives an intravitreal injection of an anti-VEGF agent in the right eye.
8. A patient with macular hole undergoes an intravitreal injection of a gas bubble in the left eye.
9. A patient with retinopathy of prematurity receives an intravitreal injection of an anti-VEGF agent in the right eye.
10. A patient with vitreomacular traction undergoes an intravitreal injection of an enzyme to dissolve the vitreous in the left eye.