How To Use CPT Code 67218

CPT 67218 describes the procedure for the destruction of a localized lesion of the retina using radiation by implantation of a source. This article will cover the description, official description, procedure, qualifying circumstances, appropriate usage, documentation requirements, billing guidelines, historical information and billing examples.

1. What is CPT Code 67218?

CPT 67218 can be used to describe the procedure in which a provider temporarily implants a radiotherapeutic source within the eye to treat a cancerous lesion within the retina. After a few days, the source is removed. This code is used for the destruction of a localized lesion of the retina using radiation by implantation of a source.

2. Official Description

The official description of CPT code 67218 is: ‘Destruction of localized lesion of retina (eg, macular edema, tumors), 1 or more sessions; radiation by implantation of source (includes removal of source).’ This code includes the removal of the source used for radiation therapy.

3. Procedure

1. The provider dilates both of the patient’s eyes and examines the fundus using a binocular indirect ophthalmoscope to identify the tumor in the eye.
2. A partial limbal peritomy is performed, which involves removing a portion of the conjunctiva extending up to the limbus.
3. The provider transilluminates the tumor to identify its silhouette and marks it with diathermy or a marking pen.
4. If necessary, extracapsular muscles may be removed to put the plaque in place.
5. A cold plaque, without seeds, is used and sewn against the muscles using sutures.
6. A lead shield is placed over the eye, and the patient is taken to the recovery area.
7. After four to five days, the provider reopens the patient’s conjunctiva, removes the plaque, and places it back into a lead container.
8. A radioactive survey is performed to ensure no radiation remains in the patient’s face, orbit, or surrounding areas.
9. The muscles are replaced and the conjunctiva is closed using sutures.
10. Subconjunctival antibiotics and steroids are injected.

4. Qualifying circumstances

CPT 67218 is used for the destruction of a localized lesion of the retina, such as macular edema or tumors. The procedure involves the temporary implantation of a radiotherapeutic source within the eye. The patient must have a qualifying condition that requires this specific treatment. The code includes the removal of the source used for radiation therapy.

5. When to use CPT code 67218

CPT code 67218 should be used when a provider performs the destruction of a localized lesion of the retina using radiation by implantation of a source. This code should be used for each session of the procedure. It is important to note that this code should only be reported once for a defined treatment period, as treatment may include one or more sessions at different encounter times.

6. Documentation requirements

To support a claim for CPT 67218, the provider must document the following information:

• Patient’s diagnosis and the need for the destruction of the localized lesion
• Details of the procedure, including the use of a radiotherapeutic source and its removal
• Date and duration of the procedure
• Any additional procedures performed, such as partial limbal peritomy or removal of extracapsular muscles
• Details of the plaque used, including whether it contained seeds or not
• Any complications or adverse reactions
• Signature of the provider performing the procedure

7. Billing guidelines

When billing for CPT 67218, ensure that the procedure involves the destruction of a localized lesion of the retina using radiation by implantation of a source. The code includes the removal of the source. If the procedure is performed bilaterally, use modifier 50. It is important to report this code only once for a defined treatment period, as treatment may include one or more sessions at different encounter times.

8. Historical information

CPT 67218 was added to the Current Procedural Terminology system on January 1, 1990. The code was later changed on January 1, 2009, with an updated description: ‘Destruction of localized lesion of retina (eg, macular edema, tumors), one or more sessions; radiation by implantation of source (includes removal of source).’ There have been no further updates to the code since its addition.

9. Examples

1. A provider performs the destruction of a localized lesion of the retina using radiation by implantation of a source for a patient with macular edema.
2. A patient with a tumor in the retina undergoes the destruction of the lesion using radiation by implantation of a source.
3. A provider performs the destruction of a localized lesion of the retina using radiation by implantation of a source for a patient with a cancerous lesion.
4. A patient with a tumor in the retina receives the destruction of the lesion using radiation by implantation of a source.
5. A provider performs the destruction of a localized lesion of the retina using radiation by implantation of a source for a patient with a malignant tumor.
6. A patient with macular edema undergoes the destruction of the lesion using radiation by implantation of a source.
7. A provider performs the destruction of a localized lesion of the retina using radiation by implantation of a source for a patient with a tumor.
8. A patient with a cancerous lesion in the retina receives the destruction of the lesion using radiation by implantation of a source.