How To Use CPT Code 67010

CPT 67010 describes the removal of vitreous humor from the eye using an anterior approach, either through an open sky technique or a limbal incision. This article will cover the description, procedure, qualifying circumstances, appropriate usage, documentation requirements, billing guidelines, historical information and billing examples.

1. What is CPT Code 67010?

CPT 67010 can be used to describe the surgical procedure in which the provider removes a significant portion of the vitreous humor, the gelatinous material that gives shape to the eye. This procedure is performed to gain access to the retina or to remove any material within the vitreous that obstructs vision. The removal is done through an anterior approach, either by using an open sky technique or a limbal incision.

2. Official Description

The official description of CPT code 67010 is: ‘Removal of vitreous, anterior approach (open sky technique or limbal incision); subtotal removal with mechanical vitrectomy.’

3. Procedure

1. The provider begins by making a small incision in the cornea, the front portion of the eye that refracts incoming light.
2. Through this incision, the provider gains access to the vitreous cavity, the space between the lens and the retina that contains the vitreous humor.
3. Using mechanical tools, such as a vitrector, the provider removes a significant portion of the vitreous material.
4. During the procedure, the provider may also aspirate most of the vitreous humor from the eye.
5. After the removal, the provider sutures the incision and may replace the aspirated vitreous with a substitute, such as air, gas, salt solution, silicone oil, or other chemicals that mimic the vitreous.

4. Qualifying circumstances

CPT 67010 is performed when the provider needs to remove a significant amount of vitreous humor from the eye. This procedure is typically done to gain access to the retina or to remove any material within the vitreous that obstructs vision. It is important to note that CPT code 67010 should not be used for the removal of vitreous by paracentesis of the anterior chamber (use CPT code 65810) or for the removal of corneovitreal adhesions (use CPT code 65880).

5. When to use CPT code 67010

CPT code 67010 should be used when the provider performs a subtotal removal of vitreous humor using an anterior approach, either through an open sky technique or a limbal incision. This code is appropriate when the removal is significant and requires the use of mechanical vitrectomy. It is important to review the documentation and ensure that the procedure meets the specific criteria outlined in the code description.

6. Documentation requirements

To support a claim for CPT 67010, the provider must document the following information:

• Reason for the procedure and the need for vitreous removal
• Details of the approach used (open sky technique or limbal incision)
• Extent of vitreous removal (subtotal removal)
• Use of mechanical vitrectomy
• Any additional procedures performed during the same operative session
• Any complications or unexpected findings
• Signature of the provider performing the procedure

7. Billing guidelines

When billing for CPT 67010, ensure that the procedure meets the specific criteria outlined in the code description. It is important to note that Medicare considers vitrectomy a component of cataract surgery and not separately payable, unless there is a documented prolapsed vitreous that is known in advance. In such cases, modifier 59 may be used to indicate a distinct procedural service. It is crucial to review payer guidelines and documentation requirements to ensure accurate and appropriate billing.

8. Historical information

CPT code 67010 was added to the Current Procedural Terminology system on January 1, 1990. There have been no updates to the code since its addition.

9. Examples

1. A patient undergoes a vitrectomy using an open sky technique to remove a significant amount of vitreous humor obstructing the retina.
2. A provider performs a limbal incision vitrectomy to remove a large amount of vitreous material that is affecting the patient’s vision.
3. During a surgical procedure, the provider performs a subtotal removal of vitreous humor using mechanical vitrectomy to gain access to the retina.
4. A patient with a retinal detachment undergoes a vitrectomy with scleral buckling to repair the detachment and remove the vitreous.
5. A provider performs a vitrectomy with retinal detachment repair and vitrectomy to address both the retinal detachment and the removal of vitreous material.
6. During a cataract surgery, the provider encounters a prolapsed vitreous and performs a vitrectomy using an open sky technique as a distinct procedural service.
7. A patient with a history of vitreous hemorrhage undergoes a vitrectomy to remove the blood and improve vision.
8. A provider performs a vitrectomy to remove vitreous floaters that are causing significant visual disturbances for the patient.
9. During a complex eye surgery, the provider performs a vitrectomy to remove vitreous material that is obstructing the surgical field.
10. A patient with a history of trauma undergoes a vitrectomy to remove any foreign bodies or debris within the vitreous cavity.