How To Use CPT Code 67042

CPT 67042 describes a surgical procedure performed on the posterior segment of the eye to remove the vitreous humor and the internal limiting membrane of the retina. 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 67042?

CPT 67042 is a code used to describe a surgical procedure performed on the posterior segment of the eye. It involves the removal of the vitreous humor, which is the gelatinous substance that fills the center of the eye, and the internal limiting membrane of the retina. This procedure is typically performed to treat conditions such as macular hole or diabetic macular edema. It may also involve the injection of air, gas, or silicone oil to stabilize the retina.

2. Official Description

The official description of CPT code 67042 is: ‘Vitrectomy, mechanical, pars plana approach; with removal of internal limiting membrane of retina (eg, for repair of macular hole, diabetic macular edema), includes, if performed, intraocular tamponade (ie, air, gas or silicone oil).’ This code specifically refers to the surgical removal of the vitreous humor and the internal limiting membrane of the retina using a mechanical cutting tool.

3. Procedure

1. The procedure begins with the patient being appropriately prepped and anesthetized.
2. The provider makes an incision through the pars plana, which is a structure in the middle of the eye between the retina and the iris.
3. A mechanical cutting instrument is inserted through the incision to remove the vitreous humor from the eye.
4. Intraocular micro forceps, a small grasping instrument, may be used to lift the edges of the internal limiting membrane of the retina.
5. The provider elevates and permanently removes the internal limiting membrane.
6. To stabilize the retina, the provider may inject air, gas, or silicone oil.
7. The incision is closed with sutures, a topical antibiotic is administered to the eye, and an eye pressure patch is applied.

4. Qualifying circumstances

CPT 67042 is typically performed to treat conditions such as macular hole or diabetic macular edema. It may also be used to remove the internal limiting membrane of the retina in cases where it is causing vision impairment. The procedure is performed by a qualified healthcare professional and may involve the injection of air, gas, or silicone oil to stabilize the retina.

5. When to use CPT code 67042

CPT code 67042 should be used when a vitrectomy is performed using a mechanical cutting tool and includes the removal of the internal limiting membrane of the retina. It is important to note that this code should only be used if the procedure involves the removal of the internal limiting membrane. If the procedure does not involve the removal of the internal limiting membrane, a different code should be used.

6. Documentation requirements

To support a claim for CPT 67042, the healthcare professional must document the following information:

• Patient’s diagnosis and the need for the vitrectomy procedure
• Details of the procedure performed, including the removal of the vitreous humor and the internal limiting membrane of the retina
• Any additional procedures performed, such as the injection of air, gas, or silicone oil
• Date of the procedure and the duration of the surgery
• Any complications or adverse events that occurred during or after the procedure
• Signature of the healthcare professional performing the procedure

7. Billing guidelines

When billing for CPT 67042, it is important to ensure that the procedure performed meets the criteria outlined in the code description. The procedure should involve the removal of the vitreous humor and the internal limiting membrane of the retina using a mechanical cutting tool. If additional procedures, such as the injection of air, gas, or silicone oil, are performed, they should be documented and billed accordingly. It is also important to follow any specific billing guidelines provided by the payer.

8. Historical information

CPT 67042 was added to the Current Procedural Terminology system on January 1, 2008. There have been no updates to the code since its addition.

9. Examples

1. A patient undergoes a vitrectomy procedure to repair a macular hole. The provider removes the vitreous humor and the internal limiting membrane of the retina using a mechanical cutting tool.
2. A patient with diabetic macular edema undergoes a vitrectomy procedure. The provider removes the vitreous humor and the internal limiting membrane of the retina and injects silicone oil to stabilize the retina.
3. A patient presents with a macular pucker and undergoes a vitrectomy procedure. The provider removes the vitreous humor and the preretinal cellular membrane using a mechanical cutting tool.
4. A patient with choroidal neovascularization undergoes a vitrectomy procedure. The provider removes the vitreous humor and the subretinal membrane and injects gas to stabilize the retina.
5. A patient with a macular hole undergoes a vitrectomy procedure. The provider removes the vitreous humor and the internal limiting membrane of the retina and injects air to stabilize the retina.