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Destruction of a localized lesion of the choroid involves the use of photodynamic therapy (PDT) to effectively ablate abnormal choroidal tissue, specifically targeting conditions such as choroidal neovascularization (CNV). CNV is characterized by the formation of new blood vessels that originate from the choroid and penetrate through the Bruch membrane into the subretinal pigment epithelium or the subretinal space, which can lead to significant vision loss. The procedure utilizes a photoactive drug, Verteporfin, which is administered intravenously prior to the application of PDT. This drug is infused over approximately 10 minutes and is given about 15 minutes before the laser treatment begins. During the procedure, a low-energy targeted laser light is directed at the lesion using a contact lens and slit lamp, allowing for precise destruction of the abnormal tissue. It is important to note that this code, CPT® 67225, is specifically used for the treatment of the second eye when both eyes are treated in a single session, and it should be billed separately in addition to the primary eye treatment, which is coded as CPT® 67221.
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The procedure is indicated for the treatment of localized lesions of the choroid, particularly in cases of choroidal neovascularization (CNV). CNV is a significant cause of vision loss and occurs when new blood vessels form in the choroid and breach the Bruch membrane, leading to potential complications in the subretinal space. The use of photodynamic therapy is specifically warranted when these lesions are present in the second eye during a single treatment session.
The procedure involves several critical steps to ensure effective treatment of the localized choroidal lesion. First, the patient receives an intravenous infusion of the photoactive drug, Verteporfin, which is administered over a period of approximately 10 minutes. This infusion is crucial as it sensitizes the targeted tissue to the subsequent laser treatment. The administration occurs about 15 minutes prior to the initiation of photodynamic therapy. Following the infusion, the physician prepares for the laser application by positioning the patient appropriately and using a contact lens in conjunction with a slit lamp. This setup allows for precise targeting of the lesion. The low-energy laser light is then directed at the localized lesion, activating the Verteporfin and leading to the destruction of the abnormal choroidal tissue. This entire process may be performed on both eyes during the same session, with CPT® 67225 specifically designated for the second eye treatment.
After the procedure, patients may experience some temporary side effects, such as visual disturbances or discomfort, which typically resolve shortly after treatment. It is essential for patients to follow any post-procedure care instructions provided by their healthcare provider, which may include monitoring for any unusual symptoms or complications. Follow-up appointments may be scheduled to assess the effectiveness of the treatment and to determine if additional interventions are necessary. The overall recovery process is generally quick, but patients should be advised to avoid bright light exposure for a specified period following the procedure, as their eyes may be more sensitive due to the photodynamic therapy.
| Short Descr | EYE PHOTODYNAMIC THER ADD-ON | Medium Descr | DSTRJ LESION CHOROID PDT 2ND EYE 1 SESSION | Long Descr | 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) | Status Code | Active Code | Global Days | ZZZ - Code Related to Another Service | PC/TC Indicator (26, TC) | 0 - Physician Service Code | Multiple Procedures (51) | 0 - No 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 | Items and Services Packaged into APC Rates | ASC Payment Indicator | Packaged service/item; no separate payment made. | Type of Service (TOS) | 2 - Surgery | Berenson-Eggers TOS (BETOS) | P4E - Eye procedure - other | MUE | 1 | CCS Clinical Classification | 17 - Destruction of lesion of retina and choroid |
This is an add-on code that must be used in conjunction with one of these primary codes.
| 67221 | MPFS Status: Restricted APC T ASC P3 PUB 100 CPT Assistant Article Destruction of localized lesion of choroid (eg, choroidal neovascularization); photodynamic therapy (includes intravenous infusion) |
| LT | Left side (used to identify procedures performed on the left side of the body) | 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). | 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.) | CC | Procedure code change (use 'cc' when the procedure code submitted was changed either for administrative reasons or because an incorrect code was filed) | 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 | RT | Right side (used to identify procedures performed on the right side of the body) |
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| 2013-01-01 | Changed | Medium Descriptor changed. |
| 2002-01-01 | Added | First appearance in code book in 2002. |
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