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The procedure described by CPT® Code 66185 involves the revision of an aqueous shunt that is connected to an extraocular equatorial plate reservoir, accompanied by the use of a graft. This surgical intervention is typically indicated for patients experiencing complications related to their aqueous shunt, which is a device used to manage intraocular pressure (IOP) in conditions such as glaucoma. The revision may be necessary due to various issues, including the formation of scar tissue at the posterior plate, which can obstruct proper drainage and lead to increased IOP. Other potential complications that may necessitate this procedure include corneal damage, the development of small cataracts, infections, and bleeding. During the revision, an incision is made in the conjunctival tissue to access the shunt, allowing for the removal of any obstructive scar tissue. Following this, a graft, which may be a scleral or corneal patch from donor tissue, is placed over the plate to secure it in position and minimize the risk of conjunctival ulceration. The procedure may also involve the application of Mitomycin C, a cytotoxic drug, to prevent the recurrence of scarring. Post-operative care includes the application of a contact lens bandage and the instillation of antibiotic and/or steroid eye drops to promote healing and prevent infection.
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The revision of an aqueous shunt to an extraocular plate reservoir, as described by CPT® Code 66185, is indicated for several specific conditions that may arise in patients with existing aqueous shunts. These indications include:
The procedure for revising an aqueous shunt involves several critical steps to ensure successful intervention. Each step is designed to address the complications associated with the shunt and restore proper function.
Post-procedure care following the revision of an aqueous shunt is essential for optimal recovery and includes several key considerations. Patients are typically advised to keep the eye patched to protect the surgical site and minimize irritation. The application of antibiotic and/or steroid eye drops is crucial to prevent infection and reduce inflammation during the healing process. Patients may also be monitored for any signs of complications, such as increased intraocular pressure or signs of infection. Follow-up appointments are necessary to assess the success of the revision and to ensure that the shunt is functioning properly. Overall, adherence to post-procedure care instructions is vital for achieving the best possible outcomes following this surgical intervention.
| Short Descr | REVISE AQUEOUS SHUNT EYE | Medium Descr | REVJ AQUEOUS SHUNT EXTRAOCULAR RESERVOIR W/GRAFT | Long Descr | Revision of aqueous shunt to extraocular equatorial plate reservoir; with graft | Status Code | Active Code | Global Days | 090 - Major Surgery | 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) | 0 - Co-surgeons not permitted for this procedure. | Team Surgery (66) | 0 - Team surgeons not permitted for this procedure. | Diagnostic Imaging Family | 99 - Concept Does Not Apply | APC Status Indicator | Hospital Part B services paid through a comprehensive APC | ASC Payment Indicator | Surgical procedure on ASC list in CY 2007; payment based on OPPS relative payment weight. | Type of Service (TOS) | 2 - Surgery | Berenson-Eggers TOS (BETOS) | P4E - Eye procedure - other | MUE | 1 | CCS Clinical Classification | 14 - Glaucoma procedures |
| RT | Right side (used to identify procedures performed on the right side of the body) | LT | Left side (used to identify procedures performed on the left side of the body) | 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). | 50 | Bilateral procedure: unless otherwise identified in the listings, bilateral procedures that are performed at the same session, should be identified by adding modifier 50 to the appropriate 5 digit code. note: this modifier should not be appended to designated "add-on" codes (see appendix d). | 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). | 54 | Surgical care only: when 1 physician or other qualified health care professional performs a surgical procedure and another provides preoperative and/or postoperative management, surgical services may be identified by adding modifier 54 to the usual procedure number. | 55 | Postoperative management only: when 1 physician or other qualified health care professional performed the postoperative management and another performed the surgical procedure, the postoperative component may be identified by adding modifier 55 to the usual procedure number. | 58 | Staged or related procedure or service by the same physician or other qualified health care professional during the postoperative period: it may be necessary to indicate that the performance of a procedure or service during the postoperative period was: (a) planned or anticipated (staged); (b) more extensive than the original procedure; or (c) for therapy following a surgical procedure. this circumstance may be reported by adding modifier 58 to the staged or related procedure. note: for treatment of a problem that requires a return to the operating/procedure room (eg, unanticipated clinical condition), see modifier 78. | 59 | Distinct procedural service: under certain circumstances, it may be necessary to indicate that a procedure or service was distinct or independent from other non-e/m services performed on the same day. modifier 59 is used to identify procedures/services, other than e/m services, that are not normally reported together, but are appropriate under the circumstances. documentation must support a different session, different procedure or surgery, different site or organ system, separate incision/excision, separate lesion, or separate injury (or area of injury in extensive injuries) not ordinarily encountered or performed on the same day by the same individual. however, when another already established modifier is appropriate it should be used rather than modifier 59. only if no more descriptive modifier is available, and the use of modifier 59 best explains the circumstances, should modifier 59 be used. note: modifier 59 should not be appended to an e/m service. to report a separate and distinct e/m service with a non-e/m service performed on the same date, see modifier 25. | 78 | Unplanned return to the operating/procedure room by the same physician or other qualified health care professional following initial procedure for a related procedure during the postoperative period: it may be necessary to indicate that another procedure was performed during the postoperative period of the initial procedure (unplanned procedure following initial procedure). when this procedure is related to the first, and requires the use of an operating/procedure room, it may be reported by adding modifier 78 to the related procedure. (for repeat procedures, see modifier 76.) | 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.) | 80 | Assistant surgeon: surgical assistant services may be identified by adding modifier 80 to the usual procedure number(s). | AG | Primary physician | AQ | Physician providing a service in an unlisted health professional shortage area (hpsa) | AS | Physician assistant, nurse practitioner, or clinical nurse specialist services for assistant at surgery | CC | Procedure code change (use 'cc' when the procedure code submitted was changed either for administrative reasons or because an incorrect code was filed) | E3 | Upper right, eyelid | GC | This service has been performed in part by a resident under the direction of a teaching physician | GW | Service not related to the hospice patient's terminal condition | Q6 | Service furnished under a fee-for-time compensation arrangement by a substitute physician or by a substitute physical therapist furnishing outpatient physical therapy services in a health professional shortage area, a medically underserved area, or a rural area | SG | Ambulatory surgical center (asc) facility service | XS | Separate structure, a service that is distinct because it was performed on a separate organ/structure | XU | Unusual non-overlapping service, the use of a service that is distinct because it does not overlap usual components of the main service |
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| 2015-01-01 | Changed | Description Changed |
| 1991-01-01 | Added | First appearance in code book in 1991. |
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