How To Use CPT Code 66172

CPT 66172 describes a specific procedure used to treat glaucoma by creating a fistula and removing part of the trabecular meshwork. This article will cover the description, official details, procedure, qualifying circumstances, appropriate usage, documentation requirements, billing guidelines, historical information and billing examples.

1. What is CPT Code 66172?

CPT 66172 is a code used to describe a surgical procedure performed to treat glaucoma. It involves creating a fistula and removing part of the trabecular meshwork in the eye. This procedure is typically done when there is scarring from previous ocular surgery or trauma. The provider may also inject antifibrotic agents to prevent fibrosis, which is the excessive production of fibrous connective tissue.

2. Official Description

The official description of CPT code 66172 is: ‘Fistulization of sclera for glaucoma; trabeculectomy ab externo with scarring from previous ocular surgery or trauma (includes injection of antifibrotic agents).’ This procedure involves creating a communication between the anterior chamber of the eye and the subconjunctival space through a scleral flap. The provider removes part of the trabecular meshwork and may inject antifibrotic agents to prevent fibrosis and scarring.

3. Procedure

1. The patient is appropriately prepped and anesthetized for the procedure.
2. The provider creates a fistula through the scleral flap, connecting the anterior chamber of the eye to the subconjunctival space.
3. Due to scarring from previous ocular surgery or trauma, the provider must navigate through the added difficulties, such as an increased risk of bleeding and scarring.
4. The provider removes part of the trabecular meshwork, which helps to increase flow and drainage in the eye.
5. To prevent fibrosis and scarring, the provider injects antifibrotic agents after the surgery.
6. The incision is carefully closed to ensure proper healing.

4. Qualifying circumstances

CPT 66172 is used when there is scarring from previous ocular surgery or trauma. This procedure is performed to treat glaucoma and relieve intraocular pressure. It is important to note that this code specifically includes the injection of antifibrotic agents to prevent fibrosis. The provider must assess the patient’s condition and determine the need for this procedure based on the presence of scarring and the patient’s symptoms.

5. When to use CPT code 66172

CPT code 66172 should be used when performing a trabeculectomy ab externo with scarring from previous ocular surgery or trauma. It is important to ensure that the patient meets the qualifying circumstances for this procedure, including the presence of scarring and the need for intraocular pressure relief. This code should not be used for cases without scarring or for other types of glaucoma procedures.

6. Documentation requirements

To support a claim for CPT code 66172, the provider must document the following information:

• Patient’s diagnosis and the presence of scarring from previous ocular surgery or trauma
• Details of the procedure performed, including the creation of the fistula, removal of trabecular meshwork, and injection of antifibrotic agents
• Date of the procedure
• Any complications or difficulties encountered during the procedure
• Incision closure details
• Signature of the provider performing the procedure

7. Billing guidelines

When billing for CPT code 66172, it is important to ensure that the procedure meets the specific criteria outlined in the code description. The provider should document the presence of scarring from previous ocular surgery or trauma and the injection of antifibrotic agents. It is also important to follow any additional guidelines provided by the payer or coding guidelines. This code should not be reported with other codes unless specifically indicated by the payer.

8. Historical information

CPT code 66172 was added to the Current Procedural Terminology system on January 1, 1994. There have been no updates or changes to the code since its addition.

9. Examples

1. A patient with scarring from previous ocular surgery undergoes a trabeculectomy ab externo with the removal of part of the trabecular meshwork and injection of antifibrotic agents.
2. A provider performs a trabeculectomy ab externo with scarring from trauma, creating a fistula and removing part of the trabecular meshwork to relieve intraocular pressure.
3. In a case of glaucoma with scarring from previous ocular surgery, a patient undergoes a trabeculectomy ab externo with the injection of antifibrotic agents to prevent fibrosis.
4. A provider performs a trabeculectomy ab externo with scarring from trauma, creating a fistula and removing part of the trabecular meshwork to improve flow and drainage in the eye.