How To Use CPT Code 67043

CPT 67043 describes the surgical excision of the vitreous, the gelatinous substance in the eye, using a mechanical cutting tool. 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 67043?

CPT 67043 can be used to describe the surgical procedure in which the provider removes the vitreous humor, the gelatinous material that gives shape to the eye, using a mechanical cutting tool. This procedure is typically performed to treat conditions such as age-related macular degeneration, where excessive growth of new vessels obstructs vision. The provider may also use air, gas, or silicone oil to stabilize the retina and may employ laser photocoagulation to heal damaged retinal tissues, if necessary.

2. Official Description

The official description of CPT code 67043 is: ‘Vitrectomy, mechanical, pars plana approach; with removal of subretinal membrane (eg, choroidal neovascularization), includes, if performed, intraocular tamponade (ie, air, gas or silicone oil) and laser photocoagulation.’

3. Procedure

1. The provider prepares the patient for the procedure, ensuring appropriate anesthesia and prepping the eye.
2. An incision is made through the pars plana, a structure in the middle of the eye between the retina and the iris.
3. A mechanical cutting tool is inserted, and the provider removes the vitreous humor from the eye.
4. An incision is made in the retina, and subretinal forceps, a grasping instrument, are used to gently elevate, peel, and remove the subretinal membrane.
5. The provider stabilizes the retina by injecting air, gas, or silicone oil.
6. If necessary, laser photocoagulation is performed to treat any retinal damage beneath the membrane.
7. The incision is closed with sutures, a topical antibiotic is administered, and an eye pressure patch is applied.

4. Qualifying circumstances

CPT 67043 is typically performed on patients with conditions such as age-related macular degeneration, where the removal of the vitreous and subretinal membrane is necessary to improve vision. The procedure may also involve the use of intraocular tamponade, such as air, gas, or silicone oil, to stabilize the retina. Laser photocoagulation may be performed to treat any retinal damage. It is important to note that CPT 67043 should not be reported for retinal detachment surgery or the removal of foreign bodies.

5. When to use CPT code 67043

CPT code 67043 should be used when the provider performs a vitrectomy using a mechanical cutting tool, removes a subretinal membrane, and includes intraocular tamponade and laser photocoagulation, if necessary. 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 67043, the provider must document the following information:

• Patient’s diagnosis and the need for vitrectomy
• Details of the procedure, including the use of a mechanical cutting tool, removal of the subretinal membrane, and any additional procedures performed
• Type of intraocular tamponade used, if applicable
• Use of laser photocoagulation, if performed
• Date of the procedure
• Signature of the provider

7. Billing guidelines

When billing for CPT 67043, ensure that the procedure meets the specific criteria outlined in the code description. It is important to report any additional procedures performed separately, if applicable. Check with your payer regarding the reporting of intraocular tamponade, as it may or may not be separately billable. It is also important to note that CPT 67043 should not be reported for retinal detachment surgery or the removal of foreign bodies.

8. Historical information

CPT 67043 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 provider performs a vitrectomy using a mechanical cutting tool, removes a subretinal membrane, and performs laser photocoagulation for a patient with age-related macular degeneration.
2. A patient with diabetic macular edema undergoes a vitrectomy with removal of the internal limiting membrane of the retina, intraocular tamponade, and laser photocoagulation.
3. A provider performs a vitrectomy with removal of a preretinal cellular membrane and intraocular tamponade for a patient with a macular pucker.
4. A patient presents with a subretinal foreign body, and the provider performs a vitrectomy to remove it.
5. A provider performs a vitrectomy with removal of an epiretinal membrane, intraocular tamponade, and laser photocoagulation for a patient with a macular pucker.