CPT® Code 0810T

Official Description

Subretinal injection of a pharmacologic agent, including vitrectomy and 1 or more retinotomies

Common Language Description

The CPT® Code 0810T refers to a specialized procedure known as a subretinal injection of a pharmacologic agent, which is performed in conjunction with vitrectomy and one or more retinotomies. This procedure is primarily utilized to deliver therapeutic pharmaceutical drugs directly into the subretinal space, which is the area located between the photoreceptors and the retinal pigment epithelium (RPE) layer of the eye. The subretinal injection is particularly significant in the treatment of various vitreoretinal diseases. It is commonly employed for administering gene therapy aimed at inherited retinal diseases, as well as for delivering tissue plasminogen activator (tPA) to address submacular hemorrhage. Additionally, the procedure may involve the injection of bevacizumab to manage large macular bleeding and the use of fluid injections to alleviate macular folds. During the procedure, the sclera, which is the white outer coating of the eyeball, is accessed through a conjunctival periotomy, allowing for the insertion of a trocar into the globe of the eye. This is followed by the placement of an infusion cannula to maintain intraocular pressure. The procedure typically involves the insertion of two additional trocars to facilitate a three-port vitrectomy, during which saline solution is injected to stabilize the intraocular environment. Any retinal tears identified during the procedure are repaired to prevent further complications. The pharmacologic agent intended for injection is prepared in a microdosing syringe, and a subretinal cannula is carefully inserted under magnification, advancing it through a small retinotomy to reach the subretinal space. The injection is then made into a viable retinal area, and the vitreous cavity is rinsed to ensure proper distribution of the medication. Air-fluid exchange may also be performed to promote the formation of subretinal blebs in the posterior pole, with thorough documentation conducted prior to the removal of the trocars. Finally, the conjunctiva is massaged over the openings, and the sclerotomies are closed. Post-procedure care includes the administration of subconjunctival corticosteroids and antibiotics, followed by the application of a wound dressing and an eye patch to support recovery.

1. Indications

The subretinal injection of a pharmacologic agent, as described by CPT® Code 0810T, is indicated for the treatment of various vitreoretinal diseases. The specific indications include:

Inherited Retinal Diseases - Conditions that affect the retina and are genetically inherited, often requiring advanced therapeutic interventions such as gene therapy.
Submacular Hemorrhage - The presence of blood beneath the macula, which can impair vision and may necessitate the use of tissue plasminogen activator (tPA) to facilitate resolution.
Large Macular Bleeding - Significant bleeding in the macular region that can lead to vision loss, where the injection of bevacizumab may be utilized to manage the condition.
Macular Folds - The presence of folds in the macula that can affect visual acuity, where fluid injection may be employed to alleviate the issue.

2. Procedure

The procedure for subretinal injection of a pharmacologic agent involves several critical steps, which are outlined as follows:

Step 1: Conjunctival Periotomy - The procedure begins with a conjunctival periotomy, which involves making an incision in the conjunctiva to expose the sclera, allowing access to the eye.
Step 2: Trocar Insertion - A trocar is inserted into the globe of the eye at the inferotemporal location. This trocar serves as a portal for further instrumentation and fluid management.
Step 3: Infusion Cannula Placement - An infusion cannula is then inserted through the previously placed trocar to maintain intraocular pressure during the procedure.
Step 4: Additional Trocar Insertions - Two additional trocars are inserted superonasally and superotemporally, facilitating a three-port vitrectomy, which is essential for accessing the vitreous cavity.
Step 5: Vitrectomy and Saline Injection - A vitrectomy is performed to remove the vitreous gel, and saline solution is injected to stabilize intraocular pressure and maintain the eye's shape.
Step 6: Retinal Tear Repair - Any identified retinal tears are repaired during the procedure to prevent further complications and ensure the integrity of the retina.
Step 7: Pharmacologic Agent Preparation - The medication intended for injection is prepared in a microdosing syringe, ensuring precise delivery of the therapeutic agent.
Step 8: Subretinal Cannula Insertion - A subretinal cannula is inserted under magnification and advanced through a small retinotomy to reach the subretinal space.
Step 9: Subretinal Injection - The pharmacologic agent is injected into a viable retinal area, targeting the specific condition being treated.
Step 10: Vitreous Cavity Rinsing - The vitreous cavity is rinsed to ensure proper distribution of the injected medication and to clear any residual materials.
Step 11: Air-Fluid Exchange - An air-fluid exchange may be performed to stimulate the formation of subretinal blebs in the posterior pole, which can aid in the therapeutic effect.
Step 12: Documentation and Trocar Removal - Thorough documentation is conducted before the removal of the trocars to ensure all procedural details are recorded.
Step 13: Conjunctiva Massage and Sclerotomy Closure - The conjunctiva is massaged over the openings, and the sclerotomies are closed to promote healing.
Step 14: Post-Procedure Care - Subconjunctival corticosteroids and antibiotics are administered to reduce inflammation and prevent infection, followed by the application of a wound dressing and an eye patch to support recovery.

3. Post-Procedure

After the completion of the subretinal injection procedure, patients are typically monitored for any immediate complications. Post-procedure care includes the administration of subconjunctival corticosteroids and antibiotics to minimize inflammation and reduce the risk of infection. A wound dressing and an eye patch are applied to protect the eye and facilitate healing. Patients may be advised on activity restrictions and follow-up appointments to assess the effectiveness of the treatment and monitor for any potential complications. It is essential for healthcare providers to provide clear instructions regarding post-operative care to ensure optimal recovery and outcomes.

Short Descr	SUBRTA NJX RX AGT W/VTRC
Medium Descr	SUBRETINAL NJX RX AGT W/VTRC & 1+ RETINOTOMIES
Long Descr	Subretinal injection of a pharmacologic agent, including vitrectomy and 1 or more retinotomies
Status Code	Carriers Price the Code
Global Days	YYY - Carrier Determines Whether Global Concept Applies
PC/TC Indicator (26, TC)	0 - Physician Service Code
Multiple Procedures (51)	2 - Standard payment adjustment rules for multiple procedures apply.
Bilateral Surgery (50)	1 - 150% payment adjustment for bilateral procedures applies.
Physician Supervisions	09 - Concept does not apply.
Assistant Surgeon (80, 82)	2 - Payment restriction for assistants at surgery does not apply to this procedure...
Co-Surgeons (62)	1 - Co-surgeons could be paid, though supporting documentation is required...
Team Surgery (66)	0 - Team surgeons not permitted for this procedure.
Diagnostic Imaging Family	99 - Concept Does Not Apply
APC Status Indicator	Procedure or Service, Multiple Reduction Applies
ASC Payment Indicator	Non office-based surgical procedure added in CY 2008 or later; payment based on OPPS relative payment weight.
Berenson-Eggers TOS (BETOS)	none
MUE	1

51	Multiple procedures: when multiple procedures, other than e/m services, physical medicine and rehabilitation services or provision of supplies (eg, vaccines), are performed at the same session by the same individual, the primary procedure or service may be reported as listed. the additional procedure(s) or service(s) may be identified by appending modifier 51 to the additional procedure or service code(s). note: this modifier should not be appended to designated "add-on" codes (see appendix d).
79	Unrelated procedure or service by the same physician or other qualified health care professional during the postoperative period: the individual may need to indicate that the performance of a procedure or service during the postoperative period was unrelated to the original procedure. this circumstance may be reported by using modifier 79. (for repeat procedures on the same day, see modifier 76.)
82	Assistant surgeon (when qualified resident surgeon not available): the unavailability of a qualified resident surgeon is a prerequisite for use of modifier 82 appended to the usual procedure code number(s).
LT	Left side (used to identify procedures performed on the left side of the body)
RT	Right side (used to identify procedures performed on the right side of the body)
TL	Early intervention/individualized family service plan (ifsp)