How To Use CPT Code 67225

CPT 67225 describes the destruction of a localized lesion of the choroid in the second eye using photodynamic therapy during a single session. 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 67225?

CPT 67225 is used to describe the destruction of a specific cancerous focus within the middle layer of the second eye using photodynamic therapy. This procedure involves the infusion of a special drug that can be activated by a laser beam. The code specifically refers to the treatment of the second eye during the same operative session as the first eye.

2. Official Description

The official description of CPT code 67225 is: ‘Destruction of localized lesion of choroid (eg, choroidal neovascularization); photodynamic therapy, second eye, at single session (List separately in addition to code for primary eye treatment)’. This code should be used in conjunction with code 67221 for the primary eye treatment.

3. Procedure

1. After completing the procedure on the first eye, the provider determines the correct contact lens for the second eye based on the size of the choroid lesion.
2. The provider calculates the laser dosimetry to determine the laser spot size and sets the laser parameters for the eye.
3. A special contact lens is placed on the cornea after instilling a calculated dose of verteporfin, a light-activated drug that binds with the abnormal tissue in the eye.
4. The provider uses an angiographic image to confirm the exact location of the lesion and selects the landmarks for the placement of the laser beam.
5. The laser is focused on the lesion, and the provider applies the laser treatment to activate the drug within the eye.
6. After completing the procedure, the contact lens is removed, and the cornea is irrigated.

4. Qualifying circumstances

CPT 67225 is performed when there is a localized lesion of the choroid in the second eye that requires destruction using photodynamic therapy. This procedure is typically used for the treatment of choroidal neovascularization (CNV), which refers to the abnormal growth of blood vessels under the retina and macula. The provider must ensure that the patient is appropriately prepped and anesthetized before performing the procedure.

5. When to use CPT code 67225

CPT code 67225 should be used when the destruction of a localized lesion in the second eye using photodynamic therapy is performed during the same operative session as the treatment of the first eye. It is important to note that this code should be reported in addition to the code for the primary eye treatment (67221).

6. Documentation requirements

To support a claim for CPT code 67225, the provider must document the following information:

• Diagnosis of the localized lesion of the choroid in the second eye
• Confirmation of the need for photodynamic therapy
• Details of the drug infusion and laser treatment, including the laser spot size, fluence, time, and magnification
• Specifics of the contact lens used and the dose of verteporfin administered
• Angiographic image confirming the location of the lesion
• Procedure start and end time
• Any additional relevant information or complications encountered during the procedure

7. Billing guidelines

When billing for CPT code 67225, it is important to ensure that the procedure is performed during the same operative session as the treatment of the first eye. This code should be reported in addition to the code for the primary eye treatment (67221). It is not appropriate to report code 67225 if the procedure on the second eye is performed in a separate session. Additionally, follow any specific guidelines provided by the payer regarding the use of modifiers or additional documentation requirements.

8. Historical information

CPT code 67225 was added to the Current Procedural Terminology system on January 1, 2002. There have been no updates or changes to the code since its addition.

9. Examples

1. A patient undergoes photodynamic therapy for a localized lesion of the choroid in their left eye. During the same operative session, the provider also performs photodynamic therapy for a localized lesion in the patient’s right eye. CPT code 67225 should be reported for the treatment of the second eye.
2. A provider performs photodynamic therapy for a localized lesion of the choroid in the patient’s left eye. Four weeks later, the patient returns for photodynamic therapy for a localized lesion in their right eye. In this case, CPT code 67221 should be reported for each procedure, as the treatment of the second eye did not occur during the same session as the first eye.