CODING Q & A

CPT Codes for Retinal Procedures Are Changed for 2008

ANSWERS PROVIDED BY RIVA LEE ASBELL

Q. Could you please review the new CPT coding changes for retina procedures for 2008? Are there any special new rules we should be aware of so that we can code these procedures more accurately and avoid the potential problems associated with many of our claims being denied?

A. Quite a bit has changed this year. Probably the most significant changes this year involving retina and vitreous coding is the deletion of CPT code 67038 and the insertion of new vitrectomy codes. You will have to study this carefully and change the way you have been coding your vitreoretinal surgeries because everyone's favorite combination of 67038 + 67108 can no longer be used.

Here are the new codes for retina/vitreous for 2008:

"67036: Vitrectomy, mechanical, pars plana approach;

67039: with focal endolaser photocoagulation

67040: with endolaser panretinal photocoagulation

67041: with removal of preretinal cellular membrane (eg, macular pucker)

67042: with removal of internal limiting membrane of retina (eg, for repair of macular hole, diabetic macular edema), includes, if performed, intraocular tamponade (ie, air, gas, or silicone oil)

67043: with removal of subretinal membrane (eg, choroidal neovascularization), includes, if performed, intraocular tamponade (ie, air, gas, or silicone oil) and laser photocoagulation

67113: Repair of complex retinal detachment (eg, proliferative vitreoretinopathy, stage C-1 or greater, diabetic traction retinal detachment, retinopathy of prematurity, retinal tear of greater than 90°), with vitrectomy and membrane peeling, may include air, gas, or silicone oil tamponade, cryotherapy, endolaser photocoagulation, drainage of subretinal fluid, scleral buckling, and/or removal of lens

67229: Treatment of extensive or progressive retinopathy, 1 or more sessions; (eg, diabetic retinopathy), photocoagulation preterm infant (less than 37 weeks gestation at birth), performed from birth up to 1 year of age (eg, retinopathy of prematurity), photocoagulation or cryotherapy."

In addition, clarification of "1 or more sessions" is provided in the following instruction: "Codes 67141, 67145, 67208-67220, 67227, 67228, 67229 include treatment at 1 or more sessions that may occur at different encounters. These codes should be reported once during a defined treatment period."

The vitrectomy codes are selfexplanatory and the complex retina code (67113) will replace many instances when codes 67038 + 67108 were used. See the example in the Table above to get you started on the right track.

CPT codes copyright 2006 American Medical Association. RP