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Destruction of a localized lesion of the choroid is a medical procedure aimed at treating conditions such as choroidal neovascularization (CNV), which is characterized by the formation of new, abnormal blood vessels in the choroid layer of the eye. These vessels can penetrate the Bruch membrane, leading to complications that may result in significant vision loss. The procedure utilizes photodynamic therapy (PDT), a technique that combines a photoactive drug with low-energy laser light to effectively ablate the targeted choroidal tissue. The photoactive drug, Verteporfin, is administered intravenously, typically over a period of approximately 10 minutes, and is given 15 minutes prior to the application of the laser treatment. This timing is crucial as it allows the drug to accumulate in the abnormal blood vessels, enhancing the effectiveness of the laser treatment. During the procedure, a contact lens and a slit lamp are employed to precisely direct the laser at the lesion, ensuring targeted destruction of the affected area. This procedure can be performed on one or both eyes in a single session, with specific coding guidelines indicating the appropriate CPT® codes to use for each eye treated.
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The procedure is indicated for the treatment of localized lesions of the choroid, specifically in cases of choroidal neovascularization (CNV). CNV is a significant cause of vision loss and is characterized by the growth of new blood vessels that can lead to complications such as retinal detachment and hemorrhage. The use of photodynamic therapy is particularly relevant for patients who exhibit these abnormal vascular changes, as it aims to halt the progression of the disease and preserve vision.
The procedure involves several key steps to ensure effective treatment of the localized lesion. First, the patient receives an intravenous infusion of the photoactive drug, Verteporfin, which is administered over approximately 10 minutes. This infusion is crucial as it allows the drug to circulate and accumulate in the abnormal blood vessels associated with the lesion. Following the infusion, there is a waiting period of about 15 minutes to allow the drug to take effect. Once this time has elapsed, the actual photodynamic therapy is initiated. A contact lens is placed on the eye to facilitate the application of the laser. A slit lamp is then used to direct a low-energy laser light precisely at the targeted lesion. The laser activates the Verteporfin, leading to the destruction of the abnormal choroidal tissue. This procedure can be performed on one eye or both eyes during the same session, with specific coding requirements for each eye treated.
After the procedure, patients may experience some temporary side effects, such as visual disturbances or discomfort in the treated eye. It is important for patients to follow up with their healthcare provider to monitor the effectiveness of the treatment and to assess for any potential complications. Recovery time can vary, but many patients can resume normal activities shortly after the procedure. However, they should be advised to avoid direct sunlight and bright lights for a period following the treatment, as the photoactive drug can make the skin and eyes more sensitive to light. Regular follow-up appointments are essential to evaluate the need for additional treatments and to ensure the best possible outcomes for vision preservation.
| Short Descr | OCULAR PHOTODYNAMIC THER | Medium Descr | DSTRJ LESION CHOROID PHOTODYNAMIC THERAPY | Long Descr | Destruction of localized lesion of choroid (eg, choroidal neovascularization); photodynamic therapy (includes intravenous infusion) | Status Code | Restricted Coverage | Global Days | 000 - Endoscopic or Minor Procedure | PC/TC Indicator (26, TC) | 0 - Physician Service Code | Multiple Procedures (51) | 2 - Standard payment adjustment rules for multiple procedures apply. | Bilateral Surgery (50) | 0 - 150% payment adjustment for bilateral procedures does NOT apply. | Physician Supervisions | 09 - Concept does not apply. | Assistant Surgeon (80, 82) | 1 - Statutory payment restriction for assistants at surgery applies 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 | Procedure or Service, Multiple Reduction Applies | ASC Payment Indicator | Office-based surgical procedure added to ASC list in CY 2008 or later with MPFS nonfacility PE RVUs; payment based on MPFS nonfacility PE RVUs. | Type of Service (TOS) | 2 - Surgery | Berenson-Eggers TOS (BETOS) | P4D - Eye procedure - treatment of retinal lesions | MUE | 1 | CCS Clinical Classification | 17 - Destruction of lesion of retina and choroid |
This is a primary code that can be used with these additional add-on codes.
| 67225 | Addon Code MPFS Status: Active Code APC N ASC N1 CPT Assistant Article 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) |
| 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) | 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). | 53 | Discontinued procedure: under certain circumstances, the physician or other qualified health care professional may elect to terminate a surgical or diagnostic procedure. due to extenuating circumstances or those that threaten the well being of the patient, it may be necessary to indicate that a surgical or diagnostic procedure was started but discontinued. this circumstance may be reported by adding modifier 53 to the code reported by the individual for the discontinued procedure. note: this modifier is not used to report the elective cancellation of a procedure prior to the patient's anesthesia induction and/or surgical preparation in the operating suite. for outpatient hospital/ambulatory surgery center (asc) reporting of a previously scheduled procedure/service that is partially reduced or cancelled as a result of extenuating circumstances or those that threaten the well being of the patient prior to or after administration of anesthesia, see modifiers 73 and 74 (see modifiers approved for asc hospital outpatient use). | 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. | 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.) | AQ | Physician providing a service in an unlisted health professional shortage area (hpsa) | GA | Waiver of liability statement issued as required by payer policy, individual case | 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 | GY | Item or service statutorily excluded, does not meet the definition of any medicare benefit or, for non-medicare insurers, is not a contract benefit | GZ | Item or service expected to be denied as not reasonable and necessary | SG | Ambulatory surgical center (asc) facility service |
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| 2013-01-01 | Changed | Medium Descriptor changed. |
| 2001-01-01 | Added | First appearance in code book in 2001. |
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