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Ophthalmology and Optometry Coding Alert

Reader Question:

Unlisted-Procedure Code, Orbitotomy May Suffice for Globe Exploration

Published on Mon Aug 23, 2004

Question: A patient was in an auto accident with airbag injury to both eyes. In the hospital, the ophthalmologist suspected rupture of the globe and performed a globe exploration. Is there a code for that?

Nevada Subscriber Answer: There is no specific CPT code for globe exploration. Typically, if the globe exploration results in a specific procedure, the exploration is included in the performed procedure. However, it may be possible to find no problem requiring additional surgical work.

Because the globe (eyeball) contains the vitreous, uvea and retina, it would be appropriate to bill 67299 (Unlisted procedure, posterior segment). If the ophthalmologist also explored the orbit (the tissues surrounding the eyeball), 67400 (Orbitotomy without bone flap [frontal or transconjunctival approach]; for exploration, with or without biopsy) might be appropriate.

You would need to confer with your ophthalmologist to determine if he also performed orbit exploration. Check to be sure documentation exists to support the billing; if so, report 67400.
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