AUG 03, 2017
Unbundling Pars Plana Vitrectomy and Prophylaxis of Retinal Detachment
Question: Can we unbundle CPT codes 67036 Pars plana vitrectomy and 67145 Prophylaxis of retinal detachment; photocoagulation with modifier -59 when performed simultaneously with or without tear?
Answer: CPT code 67145 has been bundled into 67036 since 1996. It is inappropriate to unbundle due to treatment of contiguous structures. Instead, bill CPT code 67039 Vitrectomy, mechanical, pars plana approach; with focal endolaser photocoagulation as it has the higher allowable. If both codes are submitted the payer has the option to allow the lower allowable code.
Learn more about unbundling in Retina Coding: Complete Reference Guide.