CPT Assistant, November 2021, Volume 31, Issue 11, page 9
Codes 67141 and 67145 have been revised in the Prophylaxis subsection in the Surgery section of the Current Procedural Terminology (CPT®) 2022 code set. In 2019, codes 67141 and 67145 were identified via a high-volume growth screen for services with Medicare utilization of 30,000 or more. The American Medical Association (AMA)/Specialty Society Relative Value Scale (RVS) Update Committee (RUC) recommended that codes 67141 and 67145 be referred to the CPT Editorial Panel for code descriptor revisions to align with other retinal laser photocoagulation codes to ensure appropriate reporting of these procedures by unique treatment sessions. In addition, the guidelines for this section have been deleted because the number of treatment sessions have been removed from the code descriptors. This article provides an update regarding these changes.
Prophylaxis
The descriptors for codes 67141 and 67145 have been revised to remove the reference "one or more sessions" and to remove the outdated terminology "laser or xenon arc" from code 67145. Codes 67141 and 67145 may be reported on subsequent dates for retreatment if a patient experiences a recurrence of the condition or when a repeat surgery is necessary. The procedure performed on a subsequent date would be reported with the appropriate code, as it represents additional treatment.
Coding Tip
Codes 67141 and 67145 may be reported for additional treatments for recurrence of the condition or when a repeat surgery is necessary.
If the subsequent treatment requires significantly more work or time than what is typically required, it may be appropriate to append modifier 22, Increased Procedural Services. Likewise, if the subsequent treatment requires significantly less work or time than what is typically required, it may be appropriate to append modifier 52, Reduced Services. If the subsequent treatment is performed during the postoperative period of the prior treatment, one of the following appropriate modifiers should be appended to the code: modifier 58, Staged or Related Procedure or Service by the Same Physician of Other Qualified Health Care Professional During the Postoperative Period; modifier 76, Repeat Procedure or Service by Same Physician or Other Qualified Health Care Professional; modifier 77, Repeat Procedure by Another Physician or Other Qualified Health Care Professional; or modifier 78, Unplanned Return to the Operating/Procedure Room by the Same Physician or Other Qualified Health Care Professional Following Initial Procedure for a Related Procedure During the Postoperative Period.
The following clinical examples and procedural descriptions reflect typical clinical scenarios for which these revised codes would be appropriately reported.
Clinical Example (67141)
A 66-year-old male, who has a retinal tear with a vitreous hemorrhage without retinal detachment, has cryotherapy to the retina around the tear.
Description of Procedure (67141)
Place a lid speculum in the eye. Re-examine the retina to localize the retinal tear and lattice degeneration. Place lubrication on the ocular surface and apply the cryopexy probe directly to the sclera overlying the retinal tear. Place multiple transscleral freezes with the cryopexy probe to surround the retinal tear and associated lattice degeneration while monitoring the freezes with the indirect ophthalmoscope. Reposition the patient's head as needed throughout the treatment. Remove the lid speculum. Apply a topical ointment and place a patch over the eye.
Clinical Example (67145)
A 72-year-old female, who has a retinal tear without a retinal detachment, has photocoagulation of the retina around the tear.
Description of Procedure (67145)
Re-examine the retina to localize the tear and determine the extent of the treatment. Multiple rows of laser photocoagulation surrounding the retinal tear are applied with the indirect ophthalmoscope laser delivery system using scleral depression. Reposition the patient's head and eye during the treatment to visualize the entire extent of the pathology and ensure that it is completely surrounded.
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