Ophthalmology and Optometry Coding Alert

Question: The surgeon performed a pars plana vitrectomy with epiretinal membrane peeling. He also treated a tractional retinal detachment with panretinal endolaser photocoagulation, peripheral cryopexy and air-fluid exchange. He relieved the area of tractional retinal detachment with a high-speed vitreous cutter. He also applied peripheral panendolaser photocoagulation to previously untreated areas of the retina, and treated a small retinal tear with cryopexy. How should I code this?


Ohio Subscriber


Answer: For the pars plana vitrectomy, report 67038 (Vitrectomy, mechanical, pars plana approach; with epiretinal membrane stripping).

Report 67108 (Repair of retinal detachment; with vitrectomy, any method, with or without air or gas tamponade, focal endolaser photocoagulation, cryotherapy, drainage of subretinal fluid, scleral buckling, and/or removal of lens by same technique) for the tractional retinal detachment repair.

Because 67108 (37.78 RVUs) is valued higher than 67038 (36.27 RVUs), report it on the first line of your CMS-1500 form or the electronic equivalent. Some carriers may expect you to append modifier 51 (Multiple procedures) to 67038. Your coding should look like this:

Line 1: 67108
Line 2: 67038-51. You might be tempted to report 67039 (Vitrectomy, mechanical, pars plana approach; with focal endolaser photocoagulation) or 67040 (... with endolaser panretinal photocoagulation) for the additional vitrectomies, but those codes are bundled into 67108.