CODING CORNER

What’s the Diagnosis? Part 1: Retinal Detachments

BY JOY WOODKE, COE, OCS

The key to correctly coding retina surgeries starts with the question, “What’s the diagnosis?” Retinal surgical codes are defined not only by procedure, but also by specifically linked diagnosis codes.

Part 1 in this series of four will review the correct coding for retinal detachment surgeries. This set of codes (CPT 67107, 67108, 67110, 67113) reflects the repair of a retinal detachment. However, the type of treatment and diagnosis may vary.

TYPE OF RETINAL DETACHMENT

The next step is determining the type of retinal detachment. Options are:

›› Partial with single or multiple defects, total or subtotal (ICD-9 361.01-361.02, 361.05)

›› Partial with giant tear, or with retinal dialysis (ICD-9 361.03-361.04)

›› Old detachment, partial, total, or subtotal (ICD-9 361.06-361.07), or

›› Proliferative vitreoretinopathy with tractional detachment (ICD-9 361.81)

›› If the retinal detachment diagnosis is within the range of ICD-9 361.01-361.07, the options of CPT codes to consider are:

›› 67107 – Repair of retinal detachment; scleral buckling, with or without implant, with or without cryotherapy, photocoagulation, and drainage of subretinal fluid

›› 67108 – Repair of retinal detachment; with vitrectomy, any method, with or without air or gas tamponade, focal endolaser photocoagulation, cryotherapy, drainage of subretinal fluid, scleral buckling, and/or removal of lens by same technique

›› 67110 – Repair of retinal detachment; by injection of air or other gas (e.g., pneumatic retinopexy)

* Coding Tip: It is common practice to stage (-58 mod) the repair of RD codes (lesser to greater) 67107-67110-67108

Thoughtful review of the operative report will assist in determining the correct retinal detachment code. For instance, when using a scleral buckle with cryotherapy, the correct code would be CPT code 67107, unless a vitrectomy was also performed, then it would be CPT code 67108. The same holds true for the injection of air or gas without vitrectomy, or CPT code 67110. But again, if a vitrectomy is also completed, this case would be coded as CPT code 67108.

COMPLEX RETINAL DETACHMENT

When the diagnosis is determined to be tractional, diabetic traction retinal detachment, proliferative vitreoretinopathy, retinopathy of prematurity, or a retinal tear greater than 90º, the complex retinal detachment code should be reviewed:

›› 67113 – Repair of complex retinal detachment, 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

The complex retinal detachment has an important variation from the previous repair codes. In addition to the vitrectomy, the procedure always includes a membrane peel. If the membranectomy isn’t performed, then CPT code 67108 should be used.

AVOIDING COMMON ERRORS

Understanding the repair of retinal detachment codes will help avoid costly errors in coding. For example, a surgical procedure performing vitrectomy and focal endolaser photocoagulation could make one contemplate using CPT code 67039 or CPT code 67108. But if first determining the diagnosis and the answer is retinal detachment, the correct code would be CPT code 67108. This could be a potential error costing approximately $355 in reimbursement. NRP

In the next issue: Vitrectomy Surgery for Diabetes

Ms. Woodke is an administrator with Oregon Eye Consultants, LLC.