How To Use CPT Code 67025

CPT 67025 describes the injection of a vitreous substitute into the eye using a pars plana or limbal approach. 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 67025?

CPT 67025 can be used to describe the injection of a vitreous substitute into the eye. This procedure is performed using a pars plana or limbal approach, and it may involve the removal of vitreous during the process. The purpose of the injection is to replace the vitreous or to maintain or regain intraocular pressure.

2. Official Description

The official description of CPT code 67025 is: ‘Injection of vitreous substitute, pars plana or limbal approach (fluid-gas exchange), with or without aspiration (separate procedure).’ This code is used when a provider injects a vitreous substitute into the eye using either the pars plana or limbal approach. The injection may involve a fluid-gas exchange and may or may not include aspiration as a separate procedure.

3. Procedure

1. The provider begins by sterilizing the injection site and checking the intraocular pressure.
2. An ocular speculum is placed into the patient’s eye to keep it open during the procedure.
3. The provider inserts a needle through the pars plana or limbus, aiming towards the center of the eye to avoid contact with the posterior lens.
4. The vitreous substitute, such as gas, silicone, or a spreading agent, is slowly injected into the eye.
5. The provider carefully removes the needle, using a sterile, cotton-tipped applicator to prevent reflux and steady the eye.
6. Antibiotics are applied, and the patient is transferred to a recovery room.

4. Qualifying circumstances

CPT 67025 is performed when there is a need to inject a vitreous substitute into the eye. This procedure is typically done to replace vitreous that has been removed during another surgical procedure or to maintain or regain intraocular pressure. It is important to note that this code should not be reported if the injection is performed as part of another inclusive procedure.

5. When to use CPT code 67025

CPT code 67025 should be used when a provider performs the injection of a vitreous substitute using a pars plana or limbal approach. This code is appropriate when the injection is the sole procedure being performed and is not part of another inclusive procedure.

6. Documentation requirements

To support a claim for CPT code 67025, the provider must document the following information:

• Reason for the injection and the need for a vitreous substitute
• Approach used (pars plana or limbal)
• Date of the procedure
• Details of the injection, including the type of vitreous substitute used
• Any additional procedures performed during the same session
• Signature of the provider

7. Billing guidelines

When billing for CPT code 67025, ensure that the injection is performed using either the pars plana or limbal approach. This code should not be reported if it is performed as part of another inclusive procedure. It is important to follow the specific guidelines provided by the payer to ensure accurate billing and reimbursement.

8. Historical information

CPT code 67025 was added to the Current Procedural Terminology system on January 1, 1990. The code was later revised on January 1, 2008, with a change in the description to include the term “fluid-gas exchange.”

9. Examples

1. A provider injects a gas substitute into the eye of a patient to replace vitreous that was removed during a previous surgical procedure.
2. Using a pars plana approach, a provider injects a silicone substitute into the eye to maintain intraocular pressure in a patient with a retinal detachment.
3. A limbal approach is used by a provider to inject a spreading agent into the eye to regain intraocular pressure in a patient with glaucoma.
4. During a separate procedure, a provider performs an aspiration of vitreous and then injects a vitreous substitute using a pars plana approach.
5. A provider injects a gas substitute into the eye to replace vitreous that was removed during a vitrectomy procedure.
6. Using a limbal approach, a provider injects a silicone substitute into the eye to maintain intraocular pressure in a patient with diabetic retinopathy.
7. A pars plana approach is used by a provider to inject a spreading agent into the eye to regain intraocular pressure in a patient with macular edema.
8. During a separate procedure, a provider performs an aspiration of vitreous and then injects a vitreous substitute using a limbal approach.
9. A provider injects a gas substitute into the eye to replace vitreous that was removed during a vitrectomy procedure.
10. Using a pars plana approach, a provider injects a silicone substitute into the eye to maintain intraocular pressure in a patient with a retinal tear.