How To Use CPT Code 67228

CPT 67228 describes the treatment of extensive or progressive retinopathy, specifically diabetic retinopathy, using photocoagulation. 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 67228?

CPT 67228 is used to describe the treatment of extensive or progressive retinopathy, such as diabetic retinopathy, through the use of photocoagulation. This procedure involves the destruction of tiny vessels in the retina using a laser. It is an effective treatment for retinopathy and can help prevent blindness if left untreated.

2. Official Description

The official description of CPT code 67228 is: ‘Treatment of extensive or progressive retinopathy (eg, diabetic retinopathy), photocoagulation.’

3. Procedure

1. After preparing and anesthetizing the patient, the healthcare provider measures the patient’s visual acuity and dilates their pupil.
2. The provider then applies a laser or xenon arc using either a slit lamp delivery system or an indirect ophthalmoscopic delivery system.
3. If using a slit lamp laser system, the provider applies a fundus contact lens to the patient’s eye and performs laser ablation on the midperipheral and peripheral retina.
4. If using an indirect ophthalmoscopic delivery system, the provider applies topical anesthesia to the cornea and performs laser ablation on the midperipheral and peripheral retina.

4. Qualifying circumstances

CPT 67228 is used for the treatment of extensive or progressive retinopathy, specifically diabetic retinopathy. It is important to note that this code is specifically for the treatment of vessels in the retina, not for lesions or masses on the retina. The procedure should only be reported once for a defined treatment period, as multiple sessions may be required at different encounter times. If the procedure is performed bilaterally, modifier 50 should be used.

5. When to use CPT code 67228

CPT code 67228 should be used when treating extensive or progressive retinopathy, particularly diabetic retinopathy, through photocoagulation. It is important to differentiate between this code and other codes, such as 67210, which are used for the destruction of localized lesions or masses on the retina. CPT 67228 specifically focuses on the treatment of vessels in the retina.

6. Documentation requirements

To support a claim for CPT 67228, the healthcare provider must document the following information:

• Patient’s diagnosis of extensive or progressive retinopathy, specifically diabetic retinopathy
• Date of the procedure
• Start and end time of the procedure
• Details of the procedure, including the use of laser or xenon arc and the delivery system used
• Any complications or additional procedures performed
• Signature of the healthcare provider performing the procedure

7. Billing guidelines

When billing for CPT 67228, ensure that the procedure is performed for the treatment of extensive or progressive retinopathy, specifically diabetic retinopathy. It is important to use the appropriate modifier, such as modifier 50 for bilateral procedures. It is also crucial to understand the differences between CPT 67228 and other codes, such as 67210, to accurately report the procedure performed.

8. Historical information

CPT 67228 was added to the Current Procedural Terminology system on January 1, 1990. There have been several changes to the code over the years, including updates to the description and the addition of modifiers for bilateral procedures.

9. Examples

1. A healthcare provider performs photocoagulation on a patient with extensive diabetic retinopathy to treat the vessels in the retina.
2. A patient with progressive retinopathy undergoes photocoagulation to prevent further damage to the retina.
3. A healthcare provider uses a laser to destroy the tiny vessels in the retina of a patient with extensive retinopathy.
4. Photocoagulation is performed on a patient with diabetic retinopathy to seal the vessels and prevent leakage.
5. A healthcare provider treats a patient with progressive retinopathy by using photocoagulation to target the vessels in the retina.
6. Photocoagulation is performed on a patient with extensive retinopathy to stop the growth of new vessels in the retina.
7. A patient with diabetic retinopathy undergoes photocoagulation to prevent further damage to their vision.
8. A healthcare provider uses a laser to destroy the vessels in the retina of a patient with progressive retinopathy.
9. Photocoagulation is performed on a patient with extensive diabetic retinopathy to improve their visual acuity.
10. A healthcare provider treats a patient with progressive retinopathy by using photocoagulation to seal the vessels in the retina.