Health Information Management

Q&A: Should we report injections during cataract surgery?

APCs Insider, February 27, 2015

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A: While this is a “new method” during the surgery for administering the medications, it is not unusual for injections to be provided during surgeries of any type. The “new method” is related to the fact that drops have traditionally been used for the administration of anti-inflammatory and antibiotic medications. This is not a “new method” in the sense that it is a new procedure.
The NCCI Manual very clearly states that injections provided during a surgical procedure are not separately reportable. A new reference for 2015 specifically addresses injections during cataract extraction procedures in chapter VIII, section D:
Injection of an antibiotic, steroid, and/or nonsteroidal anti-inflammatory drug during a cataract extraction procedure (e.g., CPT® codes 66820-66986) or other ophthalmic procedure is not separately reportable. Physicians should not report CPT codes such as 66020, 66030, 67028, 67500, 67515, or 68200 for such injections.
The drugs may be reported with an applicable HCPCS code and the appropriate number of units based on the HCPCS code description. The medications are considered a packaged surgical supply for the surgery (just as the eye drops are) and there is no separate payment for the medications.
However, you want to be sure to report them appropriately to include the cost as part of the surgical procedure. If the medications do not have a specific HCPCS code, you may report they with J3490 (unclassified drugs) as noted in the Claims Processing Manual, chapter 17, section 90.2. Because these are a covered part of the surgical procedure, an Advance Beneficiary Notice is not appropriate nor is it acceptable for the patient to be instructed to purchase the medications and bring them to the facility for use during the procedure.
Editor’s note: Denise Williams, RN, CPC-H, seniorvice president of revenue integrity services at Health Revenue Assurance Associates, Inc., in Plantation, Florida, answered this question.

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