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Ophthalmology and Optometry Coding Alert

Reader Questions:

Look to New HCPCS Code for Retisert

Published on Wed Feb 01, 2006

Question: Our ophthalmologists are considering using Retisert implants. What is Retisert and how should I code for it?


California Subscriber
Answer: The FDA approved the Retisert (fluocinolone acetonide) intravitreal implant in April 2005 to treat chronic noninfectious uveitis affecting the posterior segment. The ophthalmologist inserts the implant into the posterior segment through a pars plana incision.

HCPCS 2006 includes the supply code C9225 (Injection, fluocinolone acetonide intravitreal implant, per 0.59 mg). Report that along with 67027 (Implantation of intravitreal drug delivery system [e.g., ganciclovir implant], includes concomitant removal of vitreous). Note that the CPT code includes removal of vitreous; do not code separately for a vitrectomy.

Individual Medicare Part B carriers may not have coverage policies for Retisert yet; some may still consider it experimental. However, Aetna's policy considers the implant medically necessary for these diagnoses:

• 363.00-363.08--Focal chorioretinitis and focal retinochoroiditis
• 363.10-363.15--Disseminated chorioretinitis and disseminated retinochoroiditis
• 363.20--Chorioretinitis, unspecified (uveitis, posterior NOS). Learn more: Download Bausch & Lomb's package insert for Retisert at http://www.bausch.com/retisert_pi.pdf.
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