How To Use CPT Code 0472T

CPT 0472T describes the evaluation, interrogation, and initial programming of an intraocular retinal electrode array, also known as a retinal prosthesis. This article will cover the description, official description, procedure, qualifying circumstances, appropriate usage, documentation requirements, billing guidelines, historical information, and examples.

1. What is CPT Code 0472T?

CPT 0472T can be used to describe the evaluation, interrogation, and initial programming of an intraocular retinal electrode array, which is a retinal prosthesis. This code is used when a qualified healthcare professional personally evaluates and tests the artificial retina, adjusts it iteratively to test functionality, and selects optimal permanent programmed values. The code also includes visual training of the patient and a review and report by the healthcare professional.

2. Official Description

The official description of CPT code 0472T is: ‘Device evaluation, interrogation, and initial programming of intraocular retinal electrode array (eg, retinal prosthesis), in person, with iterative adjustment of the implantable device to test functionality, select optimal permanent programmed values with analysis, including visual training, with review and report by a qualified health care professional.’

3. Procedure

1. A qualified healthcare professional personally evaluates and tests the intraocular retinal electrode array.
2. The professional iteratively adjusts the implantable device to test its functionality and select optimal permanent programmed values.
3. During the evaluation, the healthcare professional provides visual training to the patient.
4. After the evaluation and adjustment process, the professional reviews and prepares a report on the findings and final settings.

4. Qualifying circumstances

CPT 0472T is used for patients who require evaluation, testing, and programming of an intraocular retinal electrode array. This device is used to treat retinal diseases such as retinitis pigmentosa, hereditary retinal disorders, and some forms of age-related macular degeneration. The procedure must be performed by a qualified healthcare professional, and the patient must meet the criteria for receiving the retinal prosthesis.

5. When to use CPT code 0472T

CPT code 0472T should be used when a qualified healthcare professional personally evaluates, tests, and programs an intraocular retinal electrode array. This code is specifically for the initial evaluation, testing, and programming of the artificial retina. It includes visual training of the patient and a review and report by the healthcare professional. It should not be reported separately for each component of the procedure.

6. Documentation requirements

To support a claim for CPT code 0472T, the healthcare professional must document the following information:

• Patient’s diagnosis and the need for evaluation, testing, and programming of the retinal prosthesis
• Specific details of the evaluation, including the iterative adjustment process and selection of permanent programmed values
• Date and duration of the evaluation and programming session
• Visual training provided to the patient
• Review and report of the findings and final settings
• Signature of the qualified healthcare professional performing the procedure

7. Billing guidelines

When billing for CPT code 0472T, ensure that the procedure is performed by a qualified healthcare professional. The code is reported for the in-person evaluation, interrogation, and initial programming of the intraocular retinal electrode array. It should not be reported separately for each component of the procedure. There are no specific guidelines regarding reporting this code with other codes.

8. Historical information

CPT code 0472T was added to the Current Procedural Terminology system on July 1, 2017. The code was later revised on January 1, 2018, with a slightly updated description. No further changes have been made to the code since its addition.

9. Examples

1. A qualified healthcare professional evaluates and tests an intraocular retinal electrode array for a patient with retinitis pigmentosa, adjusts the device iteratively, provides visual training, and prepares a review and report on the findings and final settings.
2. During an in-person session, a healthcare professional evaluates and programs a retinal prosthesis for a patient with hereditary retinal disorders, ensuring optimal permanent programmed values and providing visual training.
3. A qualified healthcare professional performs an evaluation, interrogation, and initial programming of an intraocular retinal electrode array for a patient with age-related macular degeneration, including iterative adjustment of the device, visual training, and a comprehensive review and report.
4. For a patient with retinitis pigmentosa, a healthcare professional personally evaluates and tests an intraocular retinal electrode array, selects optimal permanent programmed values, provides visual training, and prepares a detailed review and report.
5. A qualified healthcare professional performs an in-person evaluation, interrogation, and initial programming of a retinal prosthesis for a patient with hereditary retinal disorders, ensuring functionality and providing visual training, followed by a thorough review and report.
6. An intraocular retinal electrode array is evaluated and programmed by a healthcare professional for a patient with age-related macular degeneration, with iterative adjustment of the device, visual training, and a comprehensive review and report.
7. A qualified healthcare professional evaluates and tests an intraocular retinal electrode array for a patient with retinitis pigmentosa, adjusts the device iteratively, provides visual training, and prepares a review and report on the findings and final settings.
8. During an in-person session, a healthcare professional evaluates and programs a retinal prosthesis for a patient with hereditary retinal disorders, ensuring optimal permanent programmed values and providing visual training.
9. A qualified healthcare professional performs an evaluation, interrogation, and initial programming of an intraocular retinal electrode array for a patient with age-related macular degeneration, including iterative adjustment of the device, visual training, and a comprehensive review and report.
10. For a patient with retinitis pigmentosa, a healthcare professional personally evaluates and tests an intraocular retinal electrode array, selects optimal permanent programmed values, provides visual training, and prepares a detailed review and report.