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Ophthalmology and Optometry Coding Alert

You Be the Coder:

Don't Confuse 67210 and 67228

Published on Tue Oct 14, 2003

Question: Are background diabetic retinopathy and retinal edema treated by the same laser procedure, or should they have two separate CPT codes?

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Answer: Because both diagnoses require treatment of lesions in the macular region, one CPT code represents the treatment for both 362.01 (Background diabetic retinopathy) and 362.83 (Retinal edema).
 
CPT code 67210 (Destruction of localized lesion of retina [e.g., macular edema, tumors], one or more sessions; photocoagulation) treats lesions and fluid leakage in the macular region, which means it treats both 362.01 and 362.83.
 
Don't confuse the use of 67210 to treat 362.01 with the use of 67228 (Destruction of extensive or progressive retinopathy [e.g., diabetic retinopathy], one or more sessions; photocoagulation) to treat 362.02 (Proliferative diabetic retinopathy) just because the descriptor for 67228 references treatment of diabetic retinopathy. The slight difference between the degrees of diabetic retinopathy determines which laser treatment is used.
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