How To Use CPT Code 67210

CPT 67210 describes the destruction of a localized lesion of the retina using photocoagulation, which involves the use of a laser beam to heat up and destroy the tissue. 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 67210?

CPT 67210 is used to describe the destruction of a localized lesion of the retina using photocoagulation. This procedure involves the use of a laser beam that generates heat to coagulate and destroy abnormal tissues in the retina. It is typically performed when there is a need to treat conditions such as macular edema or tumors.

2. Official Description

The official description of CPT code 67210 is: ‘Destruction of localized lesion of retina (eg, macular edema, tumors), 1 or more sessions; photocoagulation.’ This code specifically refers to the use of photocoagulation to destroy a lesion in the retina.

3. Procedure

1. The patient is appropriately prepped and anesthetized for the procedure.
2. The provider places an ocular speculum in the patient’s eye to keep it open during the procedure.
3. A contact lens is placed on the patient’s eye to facilitate the procedure.
4. The provider uses a laser light to pass over the site of the lesion, guided by fluorescein angiography.
5. The laser light generates heat, which destroys the lesion of the retina.

4. Qualifying circumstances

CPT 67210 is performed when there is a localized lesion in the retina that requires destruction. This could include conditions such as macular edema or tumors. The procedure is typically performed by a provider who is experienced in using photocoagulation to treat retinal lesions.

5. When to use CPT code 67210

CPT code 67210 should be used when a provider performs photocoagulation to destroy a localized lesion in the retina. It is important to note that this code is specifically for lesions or masses on the retina, and not for treating vessels. If the provider enters the posterior chamber during the procedure, a different code may be more appropriate.

6. Documentation requirements

To support a claim for CPT code 67210, the provider must document the following information:

• The diagnosis of the patient and the need for the destruction of the retinal lesion
• The specific procedure performed, including the use of photocoagulation
• The date and duration of the procedure
• Any relevant findings or observations during the procedure
• The signature of the provider performing the procedure

7. Billing guidelines

When billing for CPT code 67210, ensure that the procedure meets the criteria for this specific code. It is important to accurately document the procedure and any necessary modifiers. If the procedure is performed bilaterally, the appropriate modifier should be used. It is also important to consider any other codes that may be relevant to the procedure and to follow any specific guidelines provided by the payer.

8. Historical information

CPT code 67210 was added to the Current Procedural Terminology system on January 1, 1990. There was a code change on January 1, 2009, which updated the description of the procedure.

9. Examples

1. A provider performs photocoagulation to destroy a localized lesion of the retina in a patient with macular edema.
2. During a procedure, a provider uses photocoagulation to treat a tumor in the retina of a patient.
3. A patient undergoes photocoagulation to destroy a lesion in the retina caused by diabetic retinopathy.
4. A provider uses photocoagulation to treat a localized lesion in the retina of a patient with choroidal neovascularization.
5. During a procedure, a provider performs photocoagulation using verteporfin to treat extensive retinopathy in a patient.