Coding for retinal laser procedures begins with identifying the diagnosis.Ĭorrect Coding: 67220-RT. The decision tree in Figure 3 indicates the correct CPT codes for retinal laser based on the specific diagnosis leading to the treatment.Ībbreviations: CME, cystoid macular edema DME, diabetic macular edema PRP, panretinal photocoagulation RD, retinal detachment.įigure 3. Had the laser procedure been performed after a pneumatic retinopexy to repair an RD, the correct code would have been 67105. What to Consider: In this case, the diagnosis leading to the laser procedure is CNVM. Patient: A 75-year-old man is seen 3 days after pneumatic displacement for subretinal hemorrhage and CNVM, OD.ĭiagnosis: Subretinal hemorrhage, AMD, and CNVM, OD.Ĭoding Options: The table to the right, CPT Code Descriptors for Retinal Laser Treatments, shows full CPT descriptions. Although the same laser may be used in the clinic, multiple CPT codes may be considered, and the correct one is determined based on the reason for treatment. Retinal Laser ProceduresĬoding for retinal laser procedures also requires consideration of the diagnosis. Payment will be 100% of the highest allowable and 50% of the lower allowable.ĬPT CODE DESCRIPTORS FOR RETINAL LASER TREATMENTSĦ7105: Repair of a retinal detachment, including drainage of subretinal fluid when performed photocoagulation.Ħ7145: Prophylaxis of retinal detachment (eg, retinal break, lattice degeneration) without drainage, one or more sessions photocoagulation.Ħ7210: Destruction of localized lesion of retina (eg, macular edema, tumors), one or more sessions photocoagulation.Ħ7220: Destruction of localized lesion of choroid (eg, choroidal neovascular membrane), one or more sessions photocoagulation (eg, laser).Ħ7228: Treatment of extensive or progressive retinopathy (eg, diabetic retinopathy), photocoagulation. NCCI edits override separate procedure language for Medicare and other payers that follow Medicare’s rules.Ĭorrect Coding: The correct coding for this case is 67025-RT and 65800-RT. The correct code for this case is 67025.Īs a paracentesis of the anterior chamber was performed, submitting the code 65800 in addition to 67025 is correct there is no National Correct Coding Initiative (NCCI) bundle. The surgical procedure was performed due to subretinal hemorrhage, and the description for 67110 requires the repair of an RD. CPT code 67110, repair of RD by injection of air or other gas, is not correct. What to Consider: In this case, pneumatic retinopexy is performed to displace the subretinal hemorrhage. RVU 3.42, Medicare nonfacility allowable $129.54 (varies by region)Ĭoding Options: The table to the right, CPT Code Descriptors for Pneumatic Procedures, shows full CPT descriptions for this diagnosis.RVU 20.85, Medicare nonfacility allowable $787.99 (varies by region)Ħ5800: Paracentesis of anterior chamber of eye (separate procedure) with removal of aqueous.RVU 25.09, Medicare nonfacility allowable $949.12 (varies by region)Ħ7025: Injection of vitreous substitute, pars plana or limbal approach (fluid-gas exchange), with or without aspiration (separate procedure). ![]() ![]() Treatment Plan: Pneumatic displacement for subretinal hemorrhage and anterior chamber tap, OD (Figure 1).ĬPT CODE DESCRIPTORS FOR PNEUMATIC PROCEDURESĦ7110: Repair of retinal detachment by injection of air or other gas (eg, pneumatic retinopexy) She has a history of bilateral wet age-related macular degeneration (AMD).ĭiagnosis: Subretinal hemorrhage, AMD, and choroidal neovascular membrane (CNVM), OD. ![]() Patient: A 70-year-old woman presents with a black blotch in her field of vision and decreased vision in her right eye (OD) for 1 week. Laser or cryotherapy may be performed during the session, but these are more commonly done postoperatively. ![]() Typically, an anterior chamber tap is performed during the surgical session. Pneumatic RETINOPEXYĪ pneumatic retinopexy is performed by injecting a gas bubble into the vitreous.
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