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67113 vs 67042 please explain the difference

louise Posted Tue 02nd of April, 2019 09:17:19 AM
1. 3-Port, 25G Pars plana vitrectomy 2. Silicone oil removal 3. Air fluid exchange 67113 vs 67042 A 25G cannula loaded on a trocar was inserted 3 mm posterior to the limbus in the inferotemporal quadrant. The infusion line was placed through the cannula. The tip of infusion line was directly visualized to be in the correct space prior to the start of infusion. Two additional 25G cannulas loaded on trocars were inserted 3 mm posterior to the limbus at the 2 o’clock and 10 o’clock positions. Through one superior cannulas, the silicone oil was removed with VFC cannula. The eye was checked with scleral depression 360 degrees and no new tear was found. Air fluid exchange was performed. The 3 cannulas were removed and sclerotomies were closed with 7-0 vicryl sutures. The intraocular pressure was palpated to be within normal limits. Subconjunctival injections ancef and solumedrol were given in the inferior cul-de-sac
SuperCoder Answered Wed 03rd of April, 2019 11:07:50 AM

Hi,

Thanks for your question.

As per the documentation provided, the approach used is pars plana vitrectomy (code range 67036-67043) therefore code 67042 will be appropriate to use rather than 67113. But the second part in the code 67042 i.e. (removal of internal limiting membrane of retina) is not addressed in the documentation above. Kindly check the code range 67036-67043 for the appropriate code to be added as per the complete documentation and indication of the procedure.

Hope this helps.

Thanks.

louise Posted Thu 04th of April, 2019 06:54:07 AM
Hello , reading over documentation no membrane is removed. 67039 or 67040 what's are thoughts ?
louise Posted Fri 05th of April, 2019 07:46:16 AM
Sorry What is your thoughts
SuperCoder Answered Fri 05th of April, 2019 08:33:44 AM

Hi,

As per the provided limited documentation given to us, the procedure performed is through pars plana vitrectomy approach. Since, the documentation is limited, please go through with the complete procedure note and choose the CPT ® code which matches with the below documentation.

  • If the provider removes vitreous fluid from the eye to access the posterior segment of the eye and introduce surgical instruments through incisions in the pars plana then code 67036.
  • If the provider removes vitreous humor from the eye to access the posterior segment of the eye and introduce surgical instruments through incisions in the pars plana. This procedure also includes the treatment of small localized areas for retinal conditions then code 67039.
  • If the provider removes vitreous humor from the eye to access the posterior segment of the eye and introduce surgical instruments through incisions in the pars plana. This procedure also includes the treatment of retinal diseases affecting a larger area of the retina then code 67040.
  • If the provider removes scar tissue from the retinal membrane that obscures vision. He removes vitreous humor, the gelatinous material that gives shape to the eye, using a mechanical cutting tool, to gain access to the scar tissue then code 67041.
  • If the provider removes vitreous humor, the gelatinous material that gives shape to the eye, using a mechanical cutting tool. He removes the internal limiting membrane of the retina to treat swelling of the macula or repair a hole in the macula. He may also inject air, gas, or silicone oil to stabilize the retina code 67042.
  • If the provider removes vitreous humor, the gelatinous material that gives shape to the eye, using a mechanical cutting tool. He then removes the subretinal membrane to treat excessive growth of new vessels that obstruct the vision, common in age related macular degeneration. He may also use air, gas or silicone oil to stabilize the retina and employ a laser beam to heal the damaged retinal tissues, if present then code 67043.

Hope this helps.

Thanks.

 

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