2008 CPT Update

In 2008, there are six significant changes in CPT that affect ophthalmology. Specifically, in the Eye and Ocular Adnexa Section of CPT, there are five new retina codes. There is also one new code in the Lacrimal System section.

The first three new codes replace CPT code 67038 Vitrectomy, mechanical, pars plana approach; with epiretinal membrane stripping, which was deleted.

• 67041 Vitrectomy, mechanical, pars plana approach; with removal of preretinal cellular membrane e.g., macular pucker

• The Correct Coding Initiative CCI, Version 14.0 bundles this procedure with the following:
  36000, 36410, 37202, 62318, 62319, 64415, 64416, 64417, 64450, 64470, 64475, 65800, 65805, 65810, 65815, 66830, 66840, 66852, 66920, 66930, 66940, 67005, 67010, 67015, 67025, 67027, 67028, 67036, 67101, 67105. 67107, 67110, 67112, 67120, 67121, 67141, 67145, 67500, 67515, 68200, 90760, 90765, 90772, 90774, 90775. Mutually exclusive 69990

• 67042 with removal of internal limiting membrane of retina e.g., for repair of macular hole, diabetic macular edema, includes, if performed, intraocular tamponade i.e., air, gas or silicone oil

• CCI edits for 67042:
  36000, 36410, 37202, 62318, 62319, 64415, 64416, 64417, 64450, 64470, 64475, 66830, 66840, 66852, 66920, 66930, 66940, 67025, 67036, 67108, 67110, 67112, 67500, 90760, 90765, 90772, 90774, 90775. Mutually Exclusive 69990

• 67043 with removal of subretinal membrane e.g., choroidal neovascularization, includes, if performed, intraocular tamponade i.e., air, gas or silicone oil and laser photocoagulation

• CCI edits for 67043:
  36000, 36410, 37202, 62318, 62319, 64415, 64416, 64417, 64450, 64470, 64475, 66830, 66840, 66852, 66920, 66930, 66940, 67025, 67036, 67107, 67108, 67110, 67112, 67113, 67500, 90760, 90765, 90772, 90774, 90775. Mutually Exclusive 69990

The other three new codes are as follows:

• 67113 Repair complex retinal detachment e.g., proliferative vitreoretinopathy, stage C-1 or greater, diabetic traction retinal detachment, retinopathy of prematurity, retinal tear of greater than 90 degrees, 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

• CCI edits for 67113:
  G0186, 36000, 36410, 37202, 62318, 62319, 64400, 64402, 64405, 64415, 64416, 64417, 64450, 64470, 64475, 66830, 66840, 66850, 66852, 66920, 66930, 66940, 66982, 66983, 66984, 66985, 66986, 67005, 67010, 67015, 67025, 67028, 67030, 67031, 67036, 67039, 67040, 67041, 67042, 67101, 67105, 67107, 67108, 67110, 67112, 67141, 67145, 67208, 67210, 67218, 67220, 67221, 67227, 67228, 67500, 67515, 68200, 90760, 90765, 90772, 90774, 90775. Mutually Exclusive 69990

• 67229 Treatment of extensive or progressive retinopathy, one or more sessions; preterm infant less than 37 weeks gestation at birth, performed from birth up to 1 year of age e.g., retinopathy of prematurity, photocoagulation or cryotherapy

• CCI edits for 67229:
  36000, 36410, 37202, 62318, 62319, 64415, 64416, 64417, 64450, 64470, 64475, 67500, 67515, 90760, 90765, 90772, 90774, 90775. Mutually Exclusive 69990

• 68816 Probing of nasolacrimal duct, with or without irrigation; with transluminal balloon catheter dilation

• This procedure has a 10-day global period.

  CCI edits for 68816:
  36000, 36410, 67202, 62318, 62319, 64415, 64416, 64417, 64450, 64470, 64475, 67500, 68810, 68811, 90760, 90765, 90772, 90774, 90775. Mutually Exclusive 69990.

In addition to the CCI edits provided for the six new CPT codes, the following CCI edits affecting other codes were added:

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About the author: Sue Vicchrilli, COT, OCS, is the coding executive for the American Academy of Ophthalmic Executives.