How To Use CPT Code 67145

CPT 67145 is a code used for prophylaxis of retinal detachment without drainage through photocoagulation. This article will cover the description, procedure, qualifying circumstances, usage, documentation requirements, billing guidelines, historical information, similar codes, and examples of CPT 67145.

1. What is CPT 67145?

CPT 67145 is a medical billing code used to describe a specific procedure performed by healthcare providers to prevent retinal detachment in patients with retinal breaks or lattice degeneration. This procedure involves the use of photocoagulation, which is the application of intense light, such as a laser, to create scar tissue and strengthen the affected area of the retina.

2. 67145 CPT code description

The official description of CPT code 67145 is: “Prophylaxis of retinal detachment (eg, retinal break, lattice degeneration) without drainage; photocoagulation.”

3. Procedure

1. The patient is prepped and possibly anesthetized.
2. The provider dilates the patient’s pupil.
3. A special lens is placed on the patient’s eye to help aim the intense light, such as a laser.
4. The provider aims the light through the dilated pupil, converting it into heat and sealing small tears in the retina.
5. The provider repeats the pulses as many times as needed, moving the light as appropriate.
6. The lens is removed, and the procedure is completed.

4. Qualifying circumstances

Patients eligible to receive CPT code 67145 services are those who have been diagnosed with retinal breaks or lattice degeneration, which are conditions that can lead to retinal detachment if left untreated. The healthcare provider must determine that photocoagulation is the most appropriate treatment option for the patient, considering factors such as the patient’s overall health, the severity of the retinal condition, and the potential risks and benefits of the procedure.

5. When to use CPT code 67145

It is appropriate to bill the 67145 CPT code when a healthcare provider performs prophylaxis of retinal detachment without drainage using photocoagulation on a patient with retinal breaks or lattice degeneration. The provider must have determined that this procedure is the most suitable treatment option for the patient’s specific condition and circumstances.

6. Documentation requirements

To support a claim for CPT 67145, healthcare providers must document the following information:

• A detailed medical history of the patient, including any previous eye conditions or treatments.
• A comprehensive eye examination, including the diagnosis of retinal breaks or lattice degeneration.
• A clear explanation of the rationale for choosing photocoagulation as the treatment method, including a discussion of alternative treatments and their potential risks and benefits.
• A step-by-step description of the procedure, including the type of laser or light source used, the number of pulses applied, and the specific areas of the retina treated.
• Any complications or adverse events that occurred during the procedure, and how they were managed.
• Postoperative care instructions and follow-up appointments.

7. Billing guidelines

When billing for CPT code 67145, healthcare providers should ensure that they have followed the appropriate documentation requirements and have obtained any necessary pre-authorizations from the patient’s insurance company. Additionally, providers should be aware of any specific billing rules or guidelines that apply to their practice setting or geographic region. It is also important to note that CPT 67143 is a similar code that describes prophylaxis of retinal detachment using cryotherapy or diathermy, so providers should ensure they are using the correct code for the specific procedure performed.

8. Historical information

CPT 67145 was added to the Current Procedural Terminology system on January 1, 1990. The code has undergone two changes since its addition:

• On January 1, 2009, the descriptor was changed from “Prophylaxis of retinal detachment (eg, retinal break, lattice degeneration) without drainage, one or more sessions; photocoagulation (laser or xenon arc)” to its current form.
• On January 1, 2022, the descriptor was changed from “Prophylaxis of retinal detachment (eg, retinal break, lattice degeneration) without drainage, 1 or more sessions; photocoagulation (laser or xenon arc)” to its current form.

9. Similar codes to CPT 67145

Five similar codes to CPT 67145 and how they differentiate are:

1. CPT 67141: This code describes prophylaxis of retinal detachment with drainage using cryotherapy or diathermy.
2. CPT 67143: This code describes prophylaxis of retinal detachment without drainage using cryotherapy or diathermy.
3. CPT 67101: This code describes repair of retinal detachment with drainage of subretinal fluid.
4. CPT 67105: This code describes repair of retinal detachment without drainage of subretinal fluid.
5. CPT 67107: This code describes repair of retinal detachment with vitrectomy.

10. Examples

Here are 10 detailed examples of CPT code 67145 procedures:

1. A patient with a history of myopia presents with a retinal break in the superior temporal quadrant. The provider performs photocoagulation to seal the break and prevent retinal detachment.
2. A patient with lattice degeneration undergoes prophylactic photocoagulation to strengthen the weakened areas of the retina and reduce the risk of detachment.
3. A patient with a horseshoe tear in the retina undergoes photocoagulation to create a barrier of scar tissue around the tear, preventing fluid from entering the subretinal space and causing detachment.
4. A patient with multiple atrophic holes in the peripheral retina undergoes photocoagulation to seal the holes and prevent retinal detachment.
5. A patient with a history of retinal detachment in the fellow eye undergoes prophylactic photocoagulation to treat areas of lattice degeneration in the unaffected eye.
6. A patient with a retinal dialysis, a type of retinal break, undergoes photocoagulation to seal the break and prevent retinal detachment.
7. A patient with a history of ocular trauma presents with a retinal break and localized subretinal fluid. The provider performs photocoagulation to seal the break and prevent further fluid accumulation and retinal detachment.
8. A patient with a history of retinal detachment surgery in one eye undergoes prophylactic photocoagulation in the fellow eye to treat areas of lattice degeneration and reduce the risk of detachment.
9. A patient with a giant retinal tear undergoes photocoagulation to create a barrier of scar tissue around the tear, preventing fluid from entering the subretinal space and causing detachment.
10. A patient with a history of uveitis presents with a retinal break and localized subretinal fluid. The provider performs photocoagulation to seal the break and prevent retinal detachment.