• New retinal tears during postoperative period


    Question: Our physician performed CPT code 67145 on a patient for a retinal tear. During the postoperative period, a new tear was found in a different area, but in the same eye. Is it appropriate to bill CPT code 67145 for the new tear?

    Answer: While CPT code 67145 Prophylaxis of retinal detachment without drainage does include the wording “1 or more sessions,” the second tear might be considered unrelated to the first tear, and as such, separately billable with modifier -79. Coverage or denial depends upon the payer.