2025 CPT code 67113
Repair of a complex retinal detachment, including vitrectomy and membrane peeling, with additional procedures as needed.
Modifiers -LT (left eye), -RT (right eye), -50 (bilateral procedure), -51 (multiple procedures), -58 (staged procedure), and -78 (unplanned return to OR) may be applicable depending on the circumstances of the case. Consult payer-specific guidelines.
Medical necessity for 67113 is established by the presence of a complex retinal detachment threatening vision.Documentation should support the complexity of the detachment and the need for the various surgical techniques employed. This includes clinical findings, imaging studies and the rationale for each aspect of the surgical procedure.
The ophthalmologist performs the procedure, including prepping the patient, administering anesthesia (if necessary), making incisions, removing vitreous humor, peeling the retinal membrane, repairing the retinal tear using cryotherapy or photocoagulation, performing scleral buckling if needed, draining subretinal fluid, injecting a vitreous substitute if necessary, and closing the incision.
- Surgery
- Surgical Procedures on the Eye and Ocular Adnexa > Surgical Procedures on the Posterior Segment of the Eye > Retina or Choroid Procedures > Repair Procedures on the Retina or Choroid
In simple words: Repair of a complicated detached retina involving removal of vitreous humor (gel-like eye substance), peeling of the retinal membrane, and reattachment using heat or cold.Additional procedures like scleral buckling (reinforcing the eye's white outer layer), fluid drainage, lens removal, or injections may be included.
Repair of complex retinal detachment (e.g., proliferative vitreoretinopathy, stage C-1 or greater, diabetic traction retinal detachment, retinopathy of prematurity, retinal tear of greater than 90 degrees), with vitrectomy and membrane peeling, including, when performed, air, gas, or silicone oil tamponade, cryotherapy, endolaser photocoagulation, drainage of subretinal fluid, scleral buckling, and/or removal of lens.
Example 1: A 60-year-old patient presents with a complex retinal detachment due to proliferative vitreoretinopathy (PVR). The surgeon performs a vitrectomy, membrane peeling, and endolaser photocoagulation. Scleral buckling is also performed to support the retina., A 72-year-old patient with diabetic traction retinal detachment undergoes a vitrectomy, membrane peeling, and subretinal fluid drainage.Silicone oil tamponade is used to maintain retinal reattachment., A premature infant with retinopathy of prematurity requires cryotherapy and scleral buckling to repair a large retinal tear.
Detailed operative report, including description of the retinal detachment, type and extent of membrane peeling, vitrectomy technique, use of cryotherapy or photocoagulation, scleral buckling details (if performed), fluid drainage (if performed), type of vitreous substitute used (if any), and post-operative management. Pre-operative imaging (e.g., OCT, fundus photography) to document the retinal detachment.Post-operative examination notes and imaging.
** Always refer to the most current CPT and payer-specific guidelines before coding.The complexity of the retinal detachment and the specific techniques used should be thoroughly documented to ensure accurate coding and reimbursement.
- Revenue Code: P4C (EYE PROCEDURE - RETINAL DETACHMENT)
- RVU: Information not available in provided sources.Refer to the most up-to-date Medicare Physician Fee Schedule for RVU values and reimbursement rates.
- Global Days: Information not available in provided sources.Global surgical periods vary by payer and procedure. Consult payer-specific guidelines.
- Payment Status: Active
- Modifier TC rule: The information provided does not specify whether a Technical Component (TC) modifier is applicable. Consult payer-specific guidelines.
- Fee Schedule: Fee schedule data is not available in the provided sources. Refer to historical Medicare Physician Fee Schedules and payer-specific fee schedules for this information.
- Specialties:Ophthalmology
- Place of Service:Ambulatory Surgical Center, Hospital Outpatient Department