Ophthalmology Coding Alert

You Be the Coder: Dont Confuse 67210 and 67228

- Published on Sat, Mar 01, 2003
Test your coding knowledge. Determine how you would code this situation before looking at the box below for the answer.

Question: Are background diabetic retinopathy and retinal edema treated by the same laser procedure, or should they have two separate CPT Codes ?

OPC Subscriber


Answer: Because both diagnoses require treatment of lesions in the macular region, one CPT code represents the treatment for both diabetic retinopathy, 362.01, and retinal edema, 362.83.

CPT code 67210 (Destruction of localized lesion of retina [e.g., macular edema, tumors] one or more sessions; photocoagulation) treats lesions and fluid leakage in the macular region, which means it treats both 362.01 and 362.83.

Don't confuse the use of 67210 to treat 362.01 with the use of 67228 (Destruction of extensive or progressive retinopathy [e.g., diabetic retinopathy], one or more sessions; photocoagulation) to treat 362.02 (Proliferative diabetic retinopathy) just because the descriptor for 67228 references treatment of diabetic retinopathy. The slight difference between the degrees of diabetic retinopathy determines which laser treatment is used.




Get 14-Day Fully-Functional Free Trial of Physician Coder

Get access to all your specialty alerts and archived articles along with some comprehensive tools including:
  • Code Search for CPT®, HCPCS, ICD-9 and ICD-10
  • CCI Edits Checker
  • Part B Fees, MUEs
  • CPT-ICD-9 CrossRef
  • CPT® ↔ ICD-9 ↔ ICD-10 CM Crosswalk
  • LCD/NCD Lookup
  • CMS 1500 Claims Scrubber
  • NDC ↔ CPT/HCPCS CrossReference
First Name: *
Last Name: *
User Name: *
E-mail: *
Phone: *
Choose Speciality*
Please enter the characters shown in box*