2025 CPT code 67028

Injection of a pharmacologic agent into the vitreous chamber of the eye (separate procedure).

Refer to the current CPT manual for complete coding guidelines.Always adhere to payer-specific guidelines for proper coding and billing.Do not report code 69990 in addition to codes 65091-68850. Modifier 59 may be necessary if this procedure is distinct from another procedure; however, use more specific modifiers such as XE, XP, XS, or XU if applicable.

Modifiers may be applicable depending on the specific circumstances.Common modifiers include -RT (right eye), -LT (left eye), -50 (bilateral procedure), and potentially modifier 59 (distinct procedural service) if performed with an unrelated procedure. Always refer to the CPT manual and payer specific guidelines.

Medical necessity for this procedure is established based on the diagnosis of a condition requiring intravitreal injection.This may include, but is not limited to, age-related macular degeneration, diabetic macular edema, retinal vein occlusion, or other retinal diseases with significant visual impairment.The documentation must support the clinical indication for the procedure.

The ophthalmologist or a qualified retina specialist is responsible for performing this procedure. Responsibilities include: site sterilization, intraocular pressure and pupil dilation checks, topical anesthesia administration, careful medication preparation and injection, verification of correct medication placement (potentially using ophthalmoscopy), antibiotic application, and patient transfer to recovery.

IMPORTANT No alternate codes explicitly listed, however, modifier 59 may be appended if the procedure is performed in conjunction with an unrelated procedure.Modifiers XE, XP, XS, or XU should be considered instead of 59 if appropriate.

In simple words: This code describes a shot of medicine given into the jelly-like fluid inside the eye. This is a separate procedure from other eye treatments done on the same day. The doctor cleans the area, numbs the eye, carefully injects the medicine, checks the placement, and applies antibiotic drops afterwards.

This CPT code, 67028, represents the intravitreal injection of a pharmaceutical agent into the vitreous cavity of the eye.The procedure involves administering medication directly into the vitreous humor, the gel-like substance filling the space between the lens and retina. This is typically performed as a separate procedure, distinct from any other eye procedures conducted on the same day.The ophthalmologist sterilizes the injection site, checks intraocular pressure and pupil dilation, applies topical anesthesia, draws the intravitreal agent into a syringe (ensuring no air bubbles), inserts the needle into the vitreous cavity, slowly administers the drug, carefully removes the needle, and may perform indirect ophthalmoscopy for medication placement verification. Post-injection, antibiotics are applied, and the patient is moved to a recovery area.

Example 1: A patient diagnosed with age-related macular degeneration (AMD) receives an intravitreal injection of anti-VEGF medication (e.g., Lucentis, Eylea, or Avastin) to inhibit neovascularization and fluid leakage., A patient with diabetic retinopathy undergoes an intravitreal injection of corticosteroids to reduce inflammation and macular edema., A patient with a retinal vein occlusion receives an intravitreal injection of anti-VEGF medication to reduce vascular leakage and edema.

* Detailed ophthalmologic examination findings before and after the procedure.* Documentation specifying the medication administered (name, dosage, and manufacturer).* Specific documentation of the injection site and technique.* Notes of any complications or adverse events during or after the procedure.* Patient's response to the treatment, including visual acuity measurements.* Justification for medical necessity (e.g., diagnosis, disease severity, and treatment plan).

** Improper injection technique can lead to complications, including infection, vitreous hemorrhage, retinal detachment, and cataract formation.Strict adherence to aseptic techniques is crucial.The specific pharmacologic agent injected should be clearly documented.Always check for payer-specific coding guidelines and local coverage determinations.

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