A new Category III code 0730T was established effective July 1, 2022, to report laser trabeculotomy, including optical coherence tomography (OCT) guidance. Although there are existing codes to report trabeculotomy (65850, 0621T, 0622T), a surgical incision is required to report these codes. The new nonsurgical procedure described by code 0730T does not involve an incision into the eye. This article clarifies the appropriate intent and reporting of code 0730T.

Category III Code

 0730T  Trabeculotomy by laser, including optical coherence tomography (OCT) guidance

(Do not report 0730T in conjunction with 65850, 65855, 92132, 0621T, 0622T)

The existing codes for reporting trabeculotomy do not accurately describe this new procedure; therefore, code 0730T was established. Some of the differences between laser trabeculotomy and the procedure(s) represented by the existing codes are explained here for clarity.

Code 65850, Trabeculotomy ab externo, describes an ab externo filtering operation by surgical creation of a fistula between the anterior chamber of the eye and the subconjunctival space through a sub-scleral excision of a portion of the trabecular meshwork (TM).

Code 0621T, Trabeculostomy ab interno by laser, describes an excimer laser trabeculostomy using a goniolens for visualization of the anterior chamber angle. This code requires a surgical incision to the cornea through which a laser probe is advanced into the eye and placed in direct contact with the TM.

Code 0622T is a child code of code 0621T and should be reported when all the components of code 0621T are performed using an ophthalmic endoscope.

Code 65855, Trabeculoplasty by laser surgery, describes an ab externo procedure. This code would not be appropriate to report because it uses a laser to thermally damage the TM, without the necessity for OCT image guidance. An exclusionary parenthetical note following code 0730T was added restricting the use of code 0730T with codes 65850, 65855, 92132, 0621T, and 0622T.

The new code 0730T differs from the existing codes because the procedure requires the use of OCT guidance by the physician to precisely target and deliver the laser beam pattern. It uses a femtosecond laser delivery system to target the TM, allowing drainage of aqueous humor. The laser trabeculotomy creates a channel for drainage through the TM to relieve intraocular pressure and does not involve a surgical incision.

Coding Tip

Code 92132, Scanning computerized ophthalmic diagnostic imaging, anterior segment, with interpretation and report, unilateral or bilateral, is not separately reported because it is inherent to code 0730T.

The following clinical example and procedural description reflect a typical clinical scenario for which these new codes would be appropriately reported.

Clinical Example (0730T)

A 68-year-old female with uncontrolled open-angle glaucoma has an elevated intraocular pressure (IOP) on maximally tolerated medical therapy. Optical coherence tomography (OCT)-guided femtosecond laser trabeculotomy is planned to reduce IOP.

Description of Procedure (0730T)

Instill topical anesthetic drops and preoperative IOP lowering or angle-opening medications in the operative eye. Lay the patient horizontally, and to stabilize the globe, place the optical patient interface on the eye and affix using suction. Insert the integrated gonioscopic camera device into the patient interface to perform an initial investigation of the iridocorneal angle and determine the best 90° segment for treatment. Remove the gonioscopic camera device and dock the laser system to the patient interface. Direct a scan of the selected segment with the OCT beam to identify the optimal location in the trabecular meshwork (TM) for the drainage channel(s).

Use the aiming beam to adjust the surgical depth and the azimuthal and circumferential positioning of the treatment target. Repeat OCT imaging to confirm the treatment target. Apply the femtosecond laser to the TM target, scanning across a preprogrammed pattern, while treatment progress is monitored on the integrated display screen. Use OCT imaging to confirm treatment success. Separate the patient interface from the delivery system and remove from the eye. Irrigate the surface of the eye to remove the coupling gel and then remove the speculum. Instill additional topical anti-inflammatory drops and measure IOP. If IOP is elevated, instill additional anti-glaucoma medications as needed or administer orally.

Reference : CPT assistant September month