2025 CPT code 67043
(Active) Effective Date: N/A Revision Date: N/A Surgery - Surgical Procedures on the Eye and Ocular Adnexa Surgery Feed
Pars plana vitrectomy with subretinal membrane removal, including intraocular tamponade and laser photocoagulation if performed.
Modifiers -LT (left eye) and -RT (right eye) are commonly used.Modifiers such as -50 (bilateral procedure), -22 (increased procedural services), -51 (multiple procedures), and -59 (distinct procedural service) might be applicable depending on the circumstances.Appropriate modifier selection depends on the specific circumstances and payer guidelines.
Medical necessity for 67043 is established by the presence of a subretinal membrane causing significant vision impairment or other ocular issues (e.g., CNV in AMD).Documentation must support the clinical indications for vitrectomy and membrane removal.
The ophthalmologist or vitreoretinal surgeon is responsible for performing this procedure, including pre-operative assessment, surgical technique, and postoperative care.
In simple words: This eye surgery involves removing a membrane under the retina that can cause vision problems. The doctor uses special tools to remove the gel-like fluid in the eye and the membrane.Air, gas, or oil may be used to support the retina, and a laser might be used to repair any damage.
This CPT code, 67043, represents a pars plana vitrectomy procedure involving the mechanical removal of the subretinal membrane.The procedure includes the use of a mechanical cutting tool for vitrectomy via a pars plana approach.Removal of the subretinal membrane (e.g., in cases of choroidal neovascularization) is a key component.If performed, the procedure also encompasses intraocular tamponade (using air, gas, or silicone oil) and laser photocoagulation to treat any associated retinal damage.The surgeon makes an incision through the pars plana, removes the vitreous humor, then makes an incision in the retina to remove the subretinal membrane with forceps.The retina is then stabilized with an injected substance, and a laser is used to treat any retinal damage.The incision is closed with sutures, and a topical antibiotic is applied.
Example 1: A 70-year-old patient presents with age-related macular degeneration (AMD) and choroidal neovascularization (CNV).A pars plana vitrectomy with subretinal membrane peel, intraocular gas tamponade, and laser photocoagulation is performed using code 67043., A 65-year-old patient with diabetic retinopathy and macular edema undergoes a pars plana vitrectomy with removal of the internal limiting membrane.Since the internal limiting membrane removal is the primary procedure, code 67042 is more appropriate., A 55-year-old patient experiences a retinal detachment that necessitates a vitrectomy and removal of a subretinal membrane.Code 67108 or 67113 (depending on the complexity) would be the more accurate codes to reflect the primary diagnosis of retinal detachment.
Detailed operative report documenting the pars plana approach, vitrectomy technique, subretinal membrane removal, type and amount of intraocular tamponade (if used), laser photocoagulation (if used), and any complications. Preoperative and postoperative notes should also be included with appropriate diagnostic testing (e.g., OCT, fundus photography).
** Always consult the most current CPT manual and payer-specific guidelines for the most accurate coding practices and reimbursement information.Specific coding choices depend heavily on the individual circumstances of the procedure and supporting documentation.Thorough documentation is key to avoiding denials.
- Revenue Code: P4C (EYE PROCEDURE - RETINAL DETACHMENT)
- RVU: This information is not provided and requires reference to the payer's specific fee schedule and RVU values.
- Global Days: The global period for this procedure varies depending on payer and specific circumstances.Consult payer guidelines for precise duration.
- Payment Status: Active
- Modifier TC rule: Not applicable.This is a complete procedure code.
- Fee Schedule: Fee schedule data is not included.Consult payer-specific fee schedules for historical and current reimbursement information.
- Specialties:Ophthalmology, Vitreoretinal Surgery
- Place of Service:Ambulatory Surgical Center, Inpatient Hospital, Outpatient Hospital