2025 CPT code 66185
(Active) Effective Date: N/A Revision Date: N/A Surgery - Surgical Procedures on the Eye and Ocular Adnexa Surgery Feed
Revision of an aqueous shunt to an extraocular equatorial plate reservoir with a graft.
Modifiers may be applicable depending on the circumstances of the procedure (e.g., 50 for bilateral procedures, 59 for distinct procedural services, 78 for unplanned return to OR).
Medical necessity for this procedure is established when there is documented failure of the initial aqueous shunt to adequately control intraocular pressure or due to complications such as infection, obstruction, or displacement.This necessitates revision to maintain visual acuity and prevent further damage.
The ophthalmologist or a qualified surgeon is responsible for performing the procedure, including pre-operative preparation, intraoperative techniques (incisions, shunt removal and replacement, graft application, suturing), and post-operative care.
In simple words: The doctor removes a previously implanted device used to drain fluid from the eye and replaces it with a new device in a different location.A small piece of tissue is used to strengthen the area where the new device is placed.
This procedure involves the removal of a previously implanted aqueous shunt due to inadequate drainage or complications.A new shunt is then placed in a different location, and a graft is used to reinforce the tissue supporting the plate. The procedure includes the injection of saline to repressurize the eye, incision into the anterior and posterior chambers, removal and replacement of the shunt tube, attachment to the scleral endplate, graft reinforcement, and closure with sutures. Post-procedure care involves topical antibiotic administration and application of an eye patch.
Example 1: A patient with glaucoma experiences recurrent elevated intraocular pressure despite having an aqueous shunt implanted six months prior.The revision with a graft is necessary to improve drainage and control pressure., A patient’s previously implanted aqueous shunt becomes infected. The infected shunt is removed, and a new one is implanted in a different location along with a graft to ensure secure placement and minimize risk of recurrence., A patient's aqueous shunt malfunctions due to a mechanical failure. The malfunctioning shunt is removed, and the surgeon installs a new shunt in a different anatomical location, reinforcing the surgical site with a graft to improve long-term stability.
* Detailed history and physical examination documenting the need for revision.* Preoperative imaging (e.g., gonioscopy, ultrasound biomicroscopy) to assess the location and condition of the existing shunt.* Intraoperative findings documenting the removal of the old shunt, placement of the new shunt, and graft use.* Postoperative examination documenting shunt patency and intraocular pressure.* Operative report detailing the procedure performed, including the type of graft used.
** The type of graft used should be documented.Specific details on the location of the new shunt should also be recorded.
- Revenue Code: P4E (EYE PROCEDURE - OTHER)
- Payment Status: Active
- Modifier TC rule: No TC modifier applies.The code encompasses the entire procedure.
- Specialties:Ophthalmology
- Place of Service:Ambulatory Surgical Center, Outpatient Hospital, Office