How To Use CPT Code 67040

CPT 67040 describes a surgical procedure known as vitrectomy, which involves the removal of the vitreous humor from the eye to gain access to the posterior segment of the eye. 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 67040?

CPT 67040 is a code used to describe a surgical procedure called vitrectomy. This procedure involves the removal of the vitreous humor, the semi-liquid substance that fills the space between the lens and the retina of the eye. The purpose of the procedure is to gain surgical access to the back part of the eye, known as the posterior segment, in order to treat retinal diseases that affect a larger area of the retina.

2. Official Description

The official description of CPT code 67040 is: ‘Vitrectomy, mechanical, pars plana approach; with endolaser panretinal photocoagulation.’

3. Procedure

1. The procedure begins with the patient being appropriately prepped and anesthetized.
2. The provider places a special contact lens on the patient’s cornea, which is the transparent membrane of the outer layer of the eyeball.
3. Using vitrectomy equipment, the provider makes incisions in the pars plana, which is the darkly pigmented posterior area of the ciliary body.
4. Three small incisions are made to insert a lighted cannula, an infusion cannula, and cutting and suction instruments.
5. The provider then removes the vitreous humor from the eye through a posterior sclerotomy.
6. In addition to the vitrectomy, the provider also performs endolaser panretinal photocoagulation, which involves using a laser probe to treat areas of retinal leakage and abnormal blood vessel growth.
7. Multiple scatter laser burns are placed in the affected areas, causing the abnormal blood vessels to shrink and potentially preventing retinal detachment.
8. Once the procedure is complete, the provider removes the instrumentation, closes the incision with sutures, and may apply a pressure patch with antibiotic ointment.

4. Qualifying circumstances

CPT 67040 is typically performed on patients with retinal diseases that require surgical intervention. These diseases may include diabetic retinopathy, which is characterized by blockages and abnormal blood vessel growth in the retina. The procedure is performed by a qualified healthcare professional and requires the use of a mechanical approach through the pars plana.

5. When to use CPT code 67040

CPT code 67040 should be used when a vitrectomy procedure is performed using a mechanical approach through the pars plana, and when endolaser panretinal photocoagulation is also performed. It is important to ensure that the procedure meets the specific criteria outlined in the code description.

6. Documentation requirements

To support a claim for CPT 67040, the healthcare professional must document the following information:

• Patient’s diagnosis and the need for vitrectomy
• Details of the procedure, including the use of a mechanical approach through the pars plana
• Date of the procedure
• Specific techniques used, such as endolaser panretinal photocoagulation
• Any complications or additional procedures performed
• Signature of the healthcare professional performing the procedure

7. Billing guidelines

When billing for CPT 67040, it is important to ensure that the procedure meets the specific criteria outlined in the code description. The procedure should be performed by a qualified healthcare professional and should include both the vitrectomy and endolaser panretinal photocoagulation. It is also important to follow any additional guidelines provided by the payer or coding guidelines.

8. Historical information

CPT 67040 was added to the Current Procedural Terminology system on January 1, 1990. There have been no updates or changes to the code since its addition.

9. Examples

1. A patient with diabetic retinopathy undergoes a vitrectomy procedure with endolaser panretinal photocoagulation to treat abnormal blood vessel growth in the retina.
2. A patient with a macular hole undergoes a vitrectomy procedure with internal limiting membrane peel and laser photocoagulation to repair the hole.
3. A patient with a subretinal membrane undergoes a vitrectomy procedure with removal of the membrane to restore normal retinal function.
4. A patient with a retinal detachment undergoes a vitrectomy procedure with air/fluid exchange to reattach the retina.
5. A patient with an epiretinal membrane undergoes a vitrectomy procedure with internal limiting membrane peel to improve visual acuity.
6. A patient with proliferative vitreoretinopathy undergoes a vitrectomy procedure with removal of preretinal cellular membrane(s) to prevent further complications.
7. A patient with a macular pucker undergoes a vitrectomy procedure with removal of subretinal membrane(s) and internal limiting membrane to improve visual acuity.
8. A patient with a retinal tear undergoes a vitrectomy procedure with scleral buckling to repair the tear and prevent retinal detachment.
9. A patient with a vitreous hemorrhage undergoes a vitrectomy procedure with removal of subretinal membrane(s) and air/fluid exchange to clear the hemorrhage and restore vision.