Summary & Overview
HCPCS Level II M1322: Post-Injection IOP Screening
HCPCS Level II code M1322 denotes a structured post-injection ophthalmic visit within seven weeks of an intraocular injection to screen for elevated intraocular pressure (IOP) using tonometry, with documentation that IOP is less than or equal to 25 mm Hg in the injected eye. This code captures a focused clinical safety check after intraocular procedures and is relevant for ophthalmology practices, ambulatory surgical centers, and payers monitoring post-procedural quality and complication surveillance. Key payers included in the national context are Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will learn what services M1322 represents, the typical site and clinical setting for claims, how common modifiers may interact with billing (listed elsewhere), and where M1322 fits within post-procedural follow-up workflows. The publication provides benchmarks and policy context relevant to coding accuracy, documentation expectations tied to IOP measurement, and payer coverage considerations. Data not available in the input for associated taxonomies, specific ICD-10 pairings, and related codes are noted in the technical sections of the full publication.
Billing Code Overview
HCPCS Level II code M1322 describes a follow-up visit occurring within seven weeks after an ocular injection in which the patient is screened for elevated intraocular pressure (IOP) using tonometry, with documented IOP ≤ 25 mm Hg for the injected eye.
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Service type: Post-injection ophthalmic IOP screening
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Typical site of service: Ophthalmology clinic or ambulatory eye care setting (office or outpatient clinic)
Clinical & Coding Specifications
Clinical Context
A typical patient is an adult receiving an intravitreal injection (e.g., anti-VEGF) for a retinal condition such as neovascular age-related macular degeneration, diabetic macular edema, or retinal vein occlusion. The patient returns to the ophthalmology clinic within seven weeks of the injection for a scheduled follow-up visit focused on screening for elevated intraocular pressure (IOP). During the visit, a licensed clinician (ophthalmologist or optometrist) performs tonometry on the injected eye, documents an IOP measurement of ≤25 mm Hg, and records findings in the medical record. The workflow commonly includes a brief history for symptoms (pain, vision change), visual acuity testing, slit-lamp exam as needed, and applanation or rebound tonometry. The encounter is specific to post-injection IOP screening within the seven-week window and is often billed using HCPCS Level II code M1322 when documentation supports the service and the IOP meets the documented criteria.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
22 | Increased procedural services | When the post-injection visit requires substantially greater work than typical (document justification). |
23 |