for Intravitreal Drug-Delivery
PROVIDED BY RIVA LEE ASBELL
can I get paid for the new technology drugs such as Retisert that are being implanted
in much the same fashion as Vitrasert and fluocinolone?
A. This is not really too much
of a coding challenge.
The correct CPT (Current Procedural
Technology) code is:
► 67027: Implantation of intravitreal
drug-delivery system (e.g., ganciclovir implant), includes concomitant removal of
For removal of drug-delivery implants
use CPT code 67121.
Of importance is the fact that
the procedure entails some incidental removal of vitreous and that the pars plana
vitrectomy should not be coded additionally. I have encountered exceptions to this,
such as in the following example:
The patient had a history of panuveitis
with a cyclitic membrane in the left eye. She also had previously undergone cataract
extraction, but not within the global period. Surgery consisted of complete
removal of the cyclitic membrane using a pars plana approach, and implantation of
the fluocinolone implant.
The case would be correctly coded
Panuveitis, left eye
364.8: Cyclitic membrane, left
67027: Insertion of fluocinolone
implant left eye LT
67036: Pars plana vitrectomy left
66830: Removal of cyclitic membrane
left eye 51-59-LT
Some coders may prefer to use 66999
rather than 66830, but the principal issue is that because a complete vitrectomy
was performed one uses CPT code 67036 and unbundles the code pairs by appending
modifier –59. The same unbundling is performed because CPT codes 67036 and
66830 are code-pair edits.
Under ordinary circumstances the
vitrectomy is not coded. If an exchange of the implant is performed, then CPT code
67027 is used in conjunction with 67121.
Q. Which modifier should I use
when removing silicone oil in the global period? Also, which CPT code is correct
– 67036 or 67121?
A. My current choice of modifier
for this is -58. CPT describes the uses of the -58 modifier as follows:
► -58 Staged or Related Procedure
or Service by the Same Physician During the Postoperative Period: The physician
may need to indicate that the performance of a procedure or service during the
postoperative period was: a) planned prospectively at the time of the original procedure
(staged); b) more extensive than the original procedure; or c) for therapy following
a diagnostic surgical procedure.
Removal of the silicone oil is
planned prospectively at the time of the insertion and different procedure codes
exist for each operation. Most vitreoretinal surgeons agree that removal of the
silicone oil is planned prospectively, although that doesn't always happen.
True, it is related to the original
procedure; however, the parallelism is that of a Hughes procedure (tarsoconjunctival
flap) or Cutler-Beard procedure (full-thickness flap) used in eyelid reconstruction,
which is then followed by severing of the reconstructed and donor eyelid areas.
In other words, you know prospectively that the oil will be removed.
Two schools of thought currently
exist in reference to which CPT code to use. The codes are described in CPT as follows:
pars plana approach
► 67121: Removal of implanted material,
posterior segment, intraocular.
I prefer to use 67121 because,
from a coder's perspective, it describes the purpose of the procedure – the
removal of the implanted material (in this case silicone oil) rather than removal
of vitreous, most of which probably is already removed.
This code was developed a long
time ago and most likely was for removal of a dropped intraocular lens; but most
coders now agree it is a completely appropriate choice for coding removal of silicone
CPT code 67121 is also used for
coding other similar situations such as removal of an intravitreal drug implantation
CPT codes copyright 2004 American
Lee Asbell is the principal in Riva Lee Asbell Associates, an ophthalmic reimbursement
firm in Philadelphia. She can be reached through her Web site at www.RivaLeeAsbell.com.
Retinal Physician, Issue: July 2005