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Extensive progressive retinopathy of a preterm infant, commonly known as retinopathy of prematurity (ROP), is a serious condition that affects premature infants, particularly those born before 37 weeks of gestation. This condition is characterized by abnormal development of retinal blood vessels, which can lead to severe vision impairment or even blindness if not treated promptly. The treatment for ROP involves either photocoagulation or cryotherapy, which are performed in one or more sessions depending on the severity of the condition. Photocoagulation utilizes laser technology to target and destroy abnormal blood vessels, while cryotherapy involves freezing the affected areas of the retina. The procedure is typically performed on infants from birth up to one year of age, with a focus on those who are particularly vulnerable, such as those born at less than 31 weeks gestation and weighing less than 1250 grams (2.75 pounds) at birth. The goal of these treatments is to halt the progression of the disease by addressing the abnormal vascularization in the retina, thereby preserving the infant's vision and preventing further complications associated with ROP.
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Retinopathy of prematurity (ROP) is primarily indicated for treatment in preterm infants who exhibit signs of extensive or progressive retinopathy. The following conditions warrant the procedure:
The procedure for treating extensive or progressive retinopathy in preterm infants involves several critical steps to ensure effective treatment while minimizing risks.
After the procedure, the infant is monitored for any immediate complications or adverse reactions to the treatment. Follow-up examinations are essential to assess the effectiveness of the treatment and to monitor the progression of ROP. Parents or guardians are provided with guidance on signs of potential complications, such as changes in vision or eye appearance, and are advised on the importance of regular follow-up appointments to ensure ongoing assessment of the infant's retinal health.
| Short Descr | TR RETINAL LES PRETERM INF | Medium Descr | EXTENSIVE RETINOPATHY 1/> SESS PRETERM INFANT | Long Descr | Treatment of extensive or progressive retinopathy, 1 or more sessions, preterm infant (less than 37 weeks gestation at birth), performed from birth up to 1 year of age (eg, retinopathy of prematurity), photocoagulation or cryotherapy | 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) | 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 without MPFS nonfacility PE RVUs; 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 | 17 - Destruction of lesion of retina and choroid |
| 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.) | 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) |
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| 2016-01-01 | Changed | Code description changed. |
| 2009-01-01 | Changed | Code description changed. |
| 2008-01-01 | Added | First appearance in code book in 2008. |
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