How To Use CPT Code 0449T

CPT 0449T describes the insertion of an aqueous drainage device into the subconjunctival space of the eye, without an extraocular reservoir. This article will cover the description, procedure, qualifying circumstances, appropriate usage, documentation requirements, billing guidelines, historical information, and examples.

1. What is CPT Code 0449T?

CPT 0449T can be used to describe the insertion of an aqueous drainage device into the subconjunctival space of the eye. This procedure is performed to lower intraocular pressure in patients with glaucoma, a condition characterized by increased pressure within the eye due to fluid buildup. The device does not include a reservoir to hold the fluid, and it drains aqueous fluid from the eye.

2. Official Description

The official description of CPT code 0449T is: ‘Insertion of aqueous drainage device, without extraocular reservoir, internal approach, into the subconjunctival space; initial device.’

3. Procedure

1. The provider prepares the patient for the procedure, typically using topical anesthesia.
2. A small incision is made either under the eyelid on the cornea (fornix-based corneal incision) or on the cornea near its junction with the sclera (limbus-based corneal incision).
3. The aqueous drainage device, such as a Baerveldt® glaucoma implant or an Ahmed® glaucoma valve, is inserted into the interior of the eye.
4. The device is placed in a way that allows it to drain into the subconjunctival space, which is the interior lining of the eyelids and the external lining of the eyeball.
5. No reservoir is implanted during this procedure.
6. The provider controls any bleeding and closes the incision in the cornea.

4. Qualifying circumstances

This procedure is performed on patients with glaucoma who require the insertion of an aqueous drainage device. The patient’s intraocular pressure must be elevated, and the device is inserted to lower the pressure. The procedure is typically performed by an ophthalmologist or other qualified eye care professional.

5. When to use CPT code 0449T

CPT code 0449T should be used when the provider performs the initial insertion of an aqueous drainage device without an extraocular reservoir into the subconjunctival space. This code should not be used for subsequent insertions of additional devices, as those should be reported with CPT code 0450T.

6. Documentation requirements

To support a claim for CPT code 0449T, the provider must document the following information:

• Patient’s diagnosis of glaucoma and the need for the aqueous drainage device
• Details of the procedure, including the type of incision made and the specific device used
• Date of the procedure
• Any complications or additional procedures performed
• Signature of the provider performing the procedure

7. Billing guidelines

When billing for CPT code 0449T, ensure that the procedure meets the criteria specified in the code description. Use modifiers LT and RT to indicate the left and right eye, respectively, if applicable. It is important to note that CPT code 0449T should not be reported with other codes related to phrenic nerve stimulation system procedures (0424T-0465T).

8. Historical information

CPT code 0449T was added to the Current Procedural Terminology system on January 1, 2017. There have been no updates to the code since its addition.

9. Examples

1. A patient with glaucoma undergoes the initial insertion of an aqueous drainage device without an extraocular reservoir into the subconjunctival space of their left eye.
2. An ophthalmologist performs the insertion of an aqueous drainage device without an extraocular reservoir into the subconjunctival space of a patient’s right eye to lower their intraocular pressure.
3. A qualified eye care professional inserts an aqueous drainage device without an extraocular reservoir into the subconjunctival space of a patient’s eye to manage their glaucoma.
4. A provider performs the initial insertion of an aqueous drainage device without an extraocular reservoir into the subconjunctival space of a patient with elevated intraocular pressure due to glaucoma.
5. An ophthalmic surgeon inserts an aqueous drainage device without an extraocular reservoir into the subconjunctival space of a patient’s eye to alleviate their glaucoma symptoms.
6. A patient with glaucoma undergoes the initial insertion of an aqueous drainage device without an extraocular reservoir into the subconjunctival space of their right eye to reduce their intraocular pressure.
7. An ophthalmologist performs the insertion of an aqueous drainage device without an extraocular reservoir into the subconjunctival space of a patient’s left eye to manage their glaucoma condition.
8. A qualified eye care professional inserts an aqueous drainage device without an extraocular reservoir into the subconjunctival space of a patient’s eye to lower their intraocular pressure caused by glaucoma.
9. A provider performs the initial insertion of an aqueous drainage device without an extraocular reservoir into the subconjunctival space of a patient with glaucoma to alleviate their elevated intraocular pressure.
10. An ophthalmic surgeon inserts an aqueous drainage device without an extraocular reservoir into the subconjunctival space of a patient’s eye to manage their glaucoma and reduce their intraocular pressure.