2025 CPT code 67040
(Active) Effective Date: N/A Revision Date: N/A Deletion Date: N/A Surgery - Surgical Procedures on the Eye and Ocular Adnexa Surgery Feed
Vitrectomy with endolaser panretinal photocoagulation.
Modifiers -LT (left eye), -RT (right eye), and -50 (bilateral procedure) may be applicable depending on the surgical site. Other modifiers may be appropriate based on specific circumstances and payer requirements (consult your local Medicare Administrative Contractor and payer guidelines).
Medical necessity is established by the presence of retinal conditions requiring vitrectomy and panretinal photocoagulation, such as proliferative diabetic retinopathy, retinal detachment, or significant vitreous hemorrhage affecting visual function.Documentation should show the severity of the condition and the inability to manage it through conservative means.
The ophthalmologist or retina specialist is responsible for performing this procedure.This includes pre-operative assessment, surgical technique, post-operative care, and follow-up management.
- Surgery
- Surgical Procedures on the Eye and Ocular Adnexa > Surgical Procedures on the Posterior Segment of the Eye > Vitreous Procedures on the Posterior Segment of the Eye
In simple words: The doctor removes some fluid from inside the eye to reach the back of the eye and perform surgery.They use a special laser to treat diseases affecting a large area of the retina.
This procedure involves a pars plana approach vitrectomy, the surgical removal of vitreous humor from the eye to access the posterior segment.Surgical instruments are introduced through incisions in the pars plana. The procedure also includes endolaser panretinal photocoagulation, a treatment for retinal diseases affecting a larger area of the retina, using a laser to create multiple burns to seal blood vessels or reduce vascular abnormalities.This is commonly performed for conditions like diabetic retinopathy.
Example 1: A patient with proliferative diabetic retinopathy undergoes vitrectomy with endolaser panretinal photocoagulation to address neovascularization and retinal ischemia., A patient with a rhegmatogenous retinal detachment (with vitreous hemorrhage) undergoes a pars plana vitrectomy with endolaser panretinal photocoagulation to treat the detachment and prevent further complications., A patient with a traumatic retinal tear and vitreous hemorrhage undergoes a pars plana vitrectomy combined with endolaser photocoagulation to seal the tear and address any hemorrhaging.
Detailed operative report specifying the approach (pars plana), instrument type (mechanical vitrectomy), and the extent of panretinal photocoagulation. Pre-operative retinal imaging (e.g., fluorescein angiography, OCT) documenting retinal pathology.Post-operative examination notes including visual acuity and retinal findings.Diagnosis codes supporting medical necessity should be clearly documented.
** The choice of this code implies that panretinal photocoagulation was performed on a significant portion of the retina.If only a limited area was treated, consider other relevant CPT codes for focal photocoagulation.Always refer to the latest CPT codebook and your payer's guidelines for the most accurate coding practices.
- Revenue Code: P4E (EYE PROCEDURE - OTHER)
- RVU: This information is not available and should be checked with the current Medicare Physician Fee Schedule (MPFS) lookup tool on the CMS website or other relevant payer's fee schedule.
- Global Days: Global surgical period information is not provided in the source data and varies depending on payer rules.Consult your payer guidelines to confirm the specific global period for this procedure in your region.
- Payment Status: Active
- Modifier TC rule: TC modifier is not typically applicable to this code.
- Fee Schedule: Historical fee schedule data is unavailable. Use the current Medicare Physician Fee Schedule (MPFS) and your payer's fee schedule for accurate reimbursement.
- Specialties:Ophthalmology, Retina Surgery
- Place of Service:Ambulatory Surgical Center, Inpatient Hospital, Outpatient Hospital