CPT® Code 0450T

Add-On Code

1. Indications

The insertion of an aqueous drainage device, as described by CPT® Code 0450T, is indicated for patients experiencing elevated intraocular pressure. This condition can lead to significant ocular complications, including:

• Chronic Intraocular Pressure Elevation - Persistent high pressure within the eye that can damage the optic nerve.
• Optic Nerve Damage - Damage to the optic nerve can result from prolonged elevated intraocular pressure, potentially leading to vision loss.
• Glaucoma - A common condition characterized by increased intraocular pressure, which may necessitate the insertion of drainage devices to manage the pressure effectively.

2. Procedure

The procedure for the insertion of an aqueous drainage device involves several critical steps to ensure proper placement and function of the device. Each step is essential for achieving the desired outcome of lowering intraocular pressure:

• Step 1: Preoperative Assessment - The surgeon conducts a thorough examination of the patient's eye, including the use of a gonioprism to inspect the angle of the anterior chamber. This assessment is crucial for determining the appropriate location for the drainage device.
• Step 2: Visualization Setup - A gonioscope is placed on the surgical microscope to enhance visualization of the trabecular meshwork, allowing the surgeon to accurately identify the target area for device insertion.
• Step 3: Incision Creation - A small, temporal, clear corneal incision is made using an AB interno phaco technique. This incision provides access to the anterior chamber of the eye.
• Step 4: Filling the Anterior Chamber - The anterior chamber is filled with viscoelastic fluid to maintain its shape and protect the intraocular structures during the procedure.
• Step 5: Device Insertion - An inserter preloaded with the aqueous drainage device is carefully traversed through the anterior chamber to the pupillary margin. The trabecular meshwork is again identified using the gonioprism, and the device is released into Schlemm’s canal.
• Step 6: Post-Insertion Care - After the device is positioned, the inserter is withdrawn. The anterior chamber is then irrigated to remove any residual viscoelastic fluid and blood, ensuring a clear surgical field.
• Step 7: Final Adjustment - The anterior chamber is filled with saline to restore normal physiologic pressure, completing the procedure and ensuring the device functions correctly.

3. Post-Procedure

Following the insertion of the aqueous drainage device, patients may require specific post-procedure care to ensure optimal recovery and device function. This includes monitoring for any signs of complications, such as infection or excessive inflammation. Patients are typically advised to follow up with their ophthalmologist for regular assessments of intraocular pressure and overall eye health. Additionally, instructions regarding the use of prescribed medications, such as anti-inflammatory or antibiotic eye drops, may be provided to aid in the healing process. It is essential for patients to adhere to these guidelines to promote successful outcomes and minimize the risk of complications.