CPT® Code 0190T | Case2Code

Code deleted, see 67299

Official Description

Placement of intraocular radiation source applicator (List separately in addition to primary procedure)

Common Language Description

The CPT® Code 0190T refers to the placement of an intraocular radiation source applicator, which is a specialized procedure performed in conjunction with a primary surgical intervention, such as vitrectomy. This procedure is specifically indicated for the treatment of choroidal neovascularization, a condition often associated with age-related macular degeneration. Choroidal neovascularization involves the abnormal growth of new blood vessels that develop at the site of a rupture in the Bruch membrane, which is a layer of tissue in the eye. These new blood vessels can invade the subretinal pigment epithelium or the subretinal space, leading to significant vision loss. During the procedure, a vitrectomy is first conducted to provide access to the vitreous cavity, allowing the surgeon to position the intraocular radiation source applicator accurately. The applicator, which contains a radiation source securely housed within a protective compartment, is inserted into the vitreous cavity and carefully positioned over the lesion. The radiation source is then advanced from its storage compartment into the cannula tip of the applicator, ensuring direct contact with the retina at the site of the neovascular lesion. This contact is maintained for a predetermined duration, typically not exceeding five minutes, to deliver the necessary radiation treatment. Once the prescribed time has elapsed, the radiation source is retracted back into the protective compartment of the applicator, which is subsequently removed from the eye. This procedure is critical for managing the complications associated with choroidal neovascularization and aims to preserve or improve vision in affected patients.

1. Indications

The placement of an intraocular radiation source applicator (CPT® Code 0190T) is indicated for the treatment of specific ocular conditions, particularly:

Choroidal Neovascularization - This condition is characterized by the growth of new, abnormal blood vessels beneath the retina, often resulting from age-related macular degeneration. It can lead to significant vision impairment and requires intervention to prevent further deterioration of sight.

2. Procedure

The procedure for the placement of the intraocular radiation source applicator involves several critical steps:

Step 1: Vitrectomy - The initial step in the procedure is the performance of a vitrectomy, which involves the surgical removal of the vitreous gel from the eye. This step is essential as it provides the necessary access to the vitreous cavity where the radiation source applicator will be placed. The vitrectomy is performed to ensure that the surgeon can effectively reach the area of the choroidal neovascular lesion.
Step 2: Insertion of the Applicator - Following the vitrectomy, the intraocular radiation source applicator is inserted into the vitreous cavity. The applicator is designed to hold a radiation source securely within a protected storage compartment, ensuring safety during the procedure. The applicator is carefully positioned over the choroidal neovascular lesion to target the affected area accurately.
Step 3: Activation of the Radiation Source - Once the applicator is in place, the radiation source is advanced from its storage compartment into the closed-chamber cannula tip of the applicator. This step is crucial as it allows the radiation source to make direct contact with the retina at the site of the neovascular lesion, delivering the necessary therapeutic radiation.
Step 4: Radiation Delivery - The radiation source remains in contact with the retina for a prescribed duration, typically not exceeding five minutes. This time frame is critical to ensure that the lesion receives an adequate dose of radiation to achieve the desired therapeutic effect while minimizing potential damage to surrounding healthy tissue.
Step 5: Retracting the Radiation Source - After the prescribed time has elapsed, the radiation source is carefully retracted back into the protected storage compartment of the applicator. This step ensures that the radiation source is safely contained and prevents any unnecessary exposure to surrounding tissues.
Step 6: Removal of the Applicator - Finally, the applicator is removed from the eye, completing the procedure. The removal is done with care to avoid any complications or trauma to the eye.

3. Post-Procedure

Post-procedure care following the placement of the intraocular radiation source applicator is essential for patient recovery and monitoring. Patients may be observed for any immediate complications, such as bleeding or infection. Follow-up appointments are typically scheduled to assess the effectiveness of the treatment and monitor for any potential side effects, including changes in vision or retinal health. Patients may also receive specific instructions regarding activity restrictions, medication use, and signs of complications that should prompt immediate medical attention. Overall, careful post-procedure management is crucial to ensure optimal outcomes and patient safety.

Short Descr	PLACE INTRAOC RADIATION SRC
Medium Descr	INTRAOCULAR RADIATION SRC APPLICATOR PLACEMENT
Long Descr	Placement of intraocular radiation source applicator (List separately in addition to primary procedure)
Status Code	Carriers Price the Code
Global Days	XXX - Global Concept Does Not Apply
PC/TC Indicator (26, TC)	0 - Physician Service Code
Multiple Procedures (51)	0 - No payment adjustment rules for multiple procedures apply.
Bilateral Surgery (50)	0 - 150% payment adjustment for bilateral procedures does NOT apply.
Physician Supervisions	09 - Concept does not apply.
Assistant Surgeon (80, 82)	0 - Payment restriction for assistants at surgery applies to this procedure...
Co-Surgeons (62)	0 - Co-surgeons not permitted for this procedure.
Team Surgery (66)	0 - Team surgeons not permitted for this procedure.
Diagnostic Imaging Family	99 - Concept Does Not Apply
APC Status Indicator	Items and Services Packaged into APC Rates
Type of Service (TOS)	9 - Other Medical Items or Services
Berenson-Eggers TOS (BETOS)	P4E - Eye procedure - other
MUE	Not applicable/unspecified.
CCS Clinical Classification	20 - Other intraocular therapeutic procedures