2025 CPT code 67036
(Active) Effective Date: N/A Revision Date: N/A Surgery - Surgical Procedures on the Eye and Ocular Adnexa Surgery Feed
Vitrectomy, mechanical, pars plana approach.
Modifiers may be used to report additional circumstances, such as bilateral procedures (modifier 50), multiple procedures (modifier 51), reduced services (modifier 52), or distinct procedural services (modifier 59).Consult the CPT manual for specific application rules and requirements.
Medical necessity for a pars plana vitrectomy is established by the presence of conditions affecting the vitreous humor or posterior segment of the eye that impair vision or threaten retinal integrity.Examples include significant vitreous hemorrhage, traction retinal detachment, macular hole, or other conditions necessitating removal of the vitreous for access and treatment.
The ophthalmologist or vitreoretinal surgeon performs the pars plana vitrectomy. This includes preparing the patient, making incisions, inserting and manipulating instruments, removing the vitreous humor, and closing the incisions.Post-operative care may also fall under the clinical responsibility.
In simple words: The doctor removes some of the gel-like fluid from inside the eye to reach the back of the eye and perform surgery. This involves making three tiny cuts to insert special instruments to remove the fluid.The cuts are then stitched up, and sometimes medicine is put in the eye to maintain pressure.A protective patch may be applied.
This procedure involves the surgical removal of vitreous humor from the eye to access the posterior segment and introduce surgical instruments through incisions in the pars plana.The vitreous humor, a semi-liquid substance filling the space between the lens and retina, is removed to gain surgical access to the back of the eye.Three small incisions are made to insert a lighted cannula, an infusion cannula, and cutting and suction instruments. The vitreous is then removed using a mechanical cutting and suctioning process. Incisions are closed with sutures, and a sterile solution may be injected to restore eye pressure. A pressure patch with antibiotic ointment may be applied.
Example 1: A patient presents with a vitreous hemorrhage obscuring vision.A pars plana vitrectomy (67036) is performed to remove the blood, restoring visual acuity., A patient with a macular hole undergoes a pars plana vitrectomy (67036) to remove the posterior vitreous and facilitate surgical repair of the hole., A patient with diabetic retinopathy experiences vitreous traction on the retina.A pars plana vitrectomy (67036) is performed to relieve this traction and prevent further retinal damage.
** Accurate coding of this procedure requires careful review of the operative report and thorough understanding of the specific details of the surgery performed.The presence or absence of other procedures, such as lens removal, membrane peeling, or laser photocoagulation, significantly impacts the appropriate choice of CPT codes and possible application of modifiers.Always refer to the most recent CPT manual and NCCI edits for accurate coding and reimbursement.
- Revenue Code: P4E (EYE PROCEDURE - OTHER)
- RVU: This information is not provided in the source.Consult the most current CMS Relative Value File (RVU) for precise details.
- Global Days: This information requires further clarification. The global period for this surgical procedure may vary depending on the complexity and additional procedures performed. Consult the most current CPT guidelines.
- Payment Status: Active
- Modifier TC rule: This is not applicable to this procedure.
- Fee Schedule: This information is not included in the provided source. Consult historical fee schedules from the relevant payer for accurate fee information.
- Specialties:Ophthalmology, Vitreoretinal Surgery
- Place of Service:Ambulatory Surgical Center, Inpatient Hospital, Outpatient Hospital