67025

⚕️ICD-10 CM 67025: Injection of vitreous substitute, liquefied gas

Code Description

ICD-10 CM 67025 describes the procedure involving the injection of vitreous substitute, liquefied gas (e.g., perfluoropropane, sulfur hexafluoride). This procedure is typically performed in an outpatient setting, such as an office-based procedure room or an Ambulatory Surgery Center (ASC).

The primary clinical intent is to provide internal tamponade to support the retina, often in the treatment of rhegmatogenous retinal detachments (pneumatic retinopexy) or specific macular holes. The gas bubble exerts pressure on the retina to facilitate reattachment or closure while the eye heals.^{AMA CPT 2024}

Note: 67025 is a CPT procedure code. Metrics such as wRVU and Assistant Payable status apply to procedural coding. HCC risk adjustment applies only to diagnosis codes (ICD-10-CM).

Hierarchical Condition Category (HCC)

• HCC Status: Not Applicable
• Reasoning: HCC (Hierarchical Condition Category) models are used for risk adjustment based on patient diagnoses (ICD-10-CM), not procedures.
• Related Diagnosis Impact: While the procedure itself does not generate HCC risk, the underlying diagnosis driving the necessity of 67025 (e.g., H33.00 Retinal Detachment) may carry HCC weight for Medicare Advantage risk adjustment.^{CMS HCC Model Documentation}

Financial & Billing Metrics

Metric	Value	Notes
wRVU	2.17	Work Relative Value Unit (2024 Medicare Physician Fee Schedule). Subject to annual update and geographic adjustment.
Total RVU	4.66	Includes Work, Practice Expense, and Malpractice components (Facility).
Assistant Payable	Yes	Assistant at Surgery Indicator: 1 (Payment allowed for assistant surgeon).
Global Period	0 Days	Post-operative period is 0 days; E/M services on the day of procedure may be bundled unless significant and separately identifiable.
Facility Pricing	Yes	Typically performed in ASC or Hospital Outpatient Department (HOPD).
Non-Facility Pricing	Yes	Can be performed in office setting with appropriate equipment.

Official Coding Guidelines

Includes

• Injection of liquefied gas into the vitreous cavity.
• Use of gases such as Perfluoropropane (C3F8) or Sulfur Hexafluoride (SF6).
• Pneumatic retinopexy component (when performed without vitrectomy).
• Internal tamponade using gas.

Excludes / Parenthetical Notes

• Do not report 67025 in conjunction with the following vitreous codes:
  • 67036 (Vitreous injection of antibiotic)
  • 67039 (Vitreous aspiration)
  • 67040 (Vitreoretinotomy)
  • 67041 (Vitreous injection of antibiotic)
  • 67042 (Vitreous injection of drug)
  • 67043 (Vitreous injection of drug)
  • Rationale: These codes represent mutually exclusive or bundled components of vitreous management.^{AMA CPT 2024}
• Separate Procedure: If performed with a more comprehensive vitreoretinal procedure (e.g., vitrectomy 67036-67043 series), 67025 is generally bundled.

Modifiers

• -50: Bilateral Procedure (If performed on both eyes during the same session).
• -RT / -LT: Right Eye / Left Eye (Required by most payers for ophthalmic codes).
• -59: Distinct Procedural Service (If performed with another unrelated procedure on the same day).
• -76: Repeat Procedure by Same Physician (If gas injection requires replenishment shortly after).
• -77: Repeat Procedure by Another Physician.

MS-DRG Assignment

• Applicability: Limited
• Reasoning: MS-DRGs (Medicare Severity Diagnosis Related Groups) are assigned based on ICD-10-PCS procedure codes for inpatient hospital stays. 67025 is a CPT code used for physician/outpatient billing.
• Inpatient Equivalent: If this procedure occurs during an inpatient admission, the hospital will code an ICD-10-PCS equivalent (e.g., Injection of therapeutic substance into vitreous).
• Associated DRGs: If the patient is admitted inpatient due to complications or severity related to the condition requiring 67025:
  • DRG 124: Other Disorders of the Eye with MCC
  • DRG 125: Other Disorders of the Eye without MCC
  • DRG 030-032: Intracranial Vascular Procedures (if related complications arise)^{CMS MS-DRG Definitions}

Code Tree (Hierarchy)

The following hierarchy illustrates the placement of 67025 within the CPT structure:

• Section: Medicine
  • Subsection: Eye and Ocular Adnexa
    • Category: Vitreous
      • Subcategory: Injection
        • Code: 67025 (Injection of vitreous substitute, liquefied gas)

Coding Examples

Example 1: Pneumatic Retinopexy

• Scenario: A patient presents with a superior rhegmatogenous retinal detachment in the right eye. The physician performs cryotherapy to the break and injects sulfur hexafluoride (SF6) gas into the vitreous cavity to tamponade the retina. No vitrectomy is performed.
• CPT Code: 67025--RT
• ICD-10-CM: H33.001 (Unspecified retinal detachment with retinal break, right eye)
• Rationale: The gas injection is the primary procedural intervention reported. Cryotherapy may be bundled or separate depending on specific payer rules, but 67025 captures the gas tamponade.^{AAO Coding Expert}

Example 2: Bilateral Injection

• Scenario: A patient with bilateral macular holes requires gas tamponade in both eyes during the same operative session.
• CPT Code: 67025--50 OR 67025--RT and 67025--LT with modifier -59 (depending on payer preference).
• ICD-10-CM: H33.819 (Macular hole, unspecified eye)
• Rationale: Modifier -50 indicates the procedure was performed on both sides.

Example 3: Exclusion Scenario (Vitrectomy)

• Scenario: The physician performs a pars plana vitrectomy (67036) and injects gas at the conclusion of the case to support the retina.
• CPT Code: 67036 ONLY.
• Rationale: Per CPT parenthetical notes, 67025 cannot be reported with 67036. The gas injection is considered integral to the vitrectomy closure.^{AMA CPT 2024}

Clinical Documentation Improvement (CDI) Tips

1. Gas Type: Document the specific type of gas used (e.g., SF6, C3F8) to support medical necessity and code selection.
2. Laterality: Always document which eye(s) were treated to ensure correct modifier usage (-RT, -LT, or -50).
3. Bundle Awareness: Ensure documentation clarifies if a vitrectomy was performed. If a vitrectomy is done, 67025 is not billable.
4. Post-Op Positioning: Document instructions given to the patient regarding head positioning, as this supports the medical necessity of the gas tamponade for specific retinal breaks.^{AAO Coding Expert}

Related Codes

• 67036: Vitrectomy, mechanical, pars plana approach
• 67039: Vitrectomy, mechanical, pars plana approach; with focal endolaser photocoagulation
• 67040: Vitrectomy, mechanical, pars plana approach; with endolaser photocoagulation
• 67041: Vitrectomy, mechanical, pars plana approach; with membrane peeling
• 67042: Vitrectomy, mechanical, pars plana approach; with complex macular hole repair
• 67043: Vitrectomy, mechanical, pars plana approach; with epiretinal membrane peeling
• H33.00: Unspecified retinal detachment with retinal break
• H33.81: Macular hole
• E11.319: Type 2 diabetes mellitus with unspecified diabetic retinopathy with macular edema

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^{AMA CPT 2024 Professional Edition CMS Medicare Physician Fee Schedule 2024 CMS MS-DRG Definitions Manual American Academy of Ophthalmology Coding Expert CMS HCC Risk Adjustment Model Documentation}