Differentiate Hot from Cold When Reporting Retinal Repair

CPT® 2017 revised two codes used to report retinal detachment repair:
67101 Repair of retinal detachment, including drainage of subretinal fluid when performed; cryotherapy
67105 photocoagulation
The descriptor for 67101 now specifies cryotherapy as the sole method of repair. Similarly, 67105 now specifies photocoagulation repair of a detached retina, only. In both cases, the code descriptors were revised to eliminate the reference to “1 or more sessions.”
The global period for both 67101 and 67105 has been changed from 90 days to 10 days.
Codes 67101 and 67105 describe two methods to achieve the same ends: repair of a detached retina. Code 67101 specifies cryotherapy (extreme cold). The surgeon uses a microscope to identify tears in the retina, and then uses a cryoprobe to freeze the tissue and cauterize the tears. Code 67105 specifies the same type of repair by photocoagulation (using a laser beam to heat the tissue). In both cases, when necessary, the surgeon also may drain subretinal fluid. Either procedure may require multiple sessions to complete.
Do not report 67101 and 67105 for the same eye during the same session, per CPT® Assistant (February 2017; Vol. 27: Issue 2):
Question: A 17-year-old female with a history of a drifting left eye presents with poor vision and a total retinal detachment in the left eye. In the operating room, she undergoes drainage of subretinal fluid and both cryotherapy and laser to a vascular tumor. If two different technologies (photocoagulation and cryotherapy) are used in the same session, may both code 67101, Repair of retinal detachment, including drainage of subretinal fluid when performed; cryotherapy, and code 67105, Repair of retinal detachment, including drainage of subretinal fluid when performed; photocoagulation, be reported?
Answer: No. Report the technology that was primarily applied, or the most time-intensive service. It is not appropriate to select a code based on equipment costs or relative value unit.

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John Verhovshek

John Verhovshek, MA, CPC, is a contributing editor at AAPC. He has been covering medical coding and billing, healthcare policy, and the business of medicine since 1999. He is an alumnus of York College of Pennsylvania and Clemson University.

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