CPT® Code 0474T

Official Description

Insertion of anterior segment aqueous drainage device, with creation of intraocular reservoir, internal approach, into the supraciliary space

Common Language Description

The procedure described by CPT® Code 0474T involves the insertion of an anterior segment aqueous drainage device, which is specifically designed to manage intraocular pressure in patients with mild to moderate primary open-angle glaucoma. This condition is characterized by an increase in intraocular pressure due to impaired drainage of aqueous humor, the fluid that maintains intraocular pressure and provides nutrients to the eye. The drainage device is cylindrical and fenestrated, meaning it has openings that allow for the outflow of aqueous fluid. It is strategically placed in the supraciliary space, which is the area between the sclera (the white outer layer of the eyeball) and the ciliary body (the part of the eye that produces aqueous humor). The internal approach used in this procedure involves creating an intraocular reservoir that facilitates the drainage of excess fluid, thereby reducing intraocular pressure and potentially preventing damage to the optic nerve. The device is inserted using a guidewire and a handheld applier, which are introduced through a small incision in the eye called a paracentesis. Under microscopic guidance, the applier is maneuvered through the anterior chamber of the eye to the designated implantation site. Once positioned correctly, the device is deployed into the supraciliary space, ensuring that only the proximal retention ring remains in the anterior chamber. This innovative technique aims to provide a more effective and less invasive option for glaucoma management, enhancing patient outcomes and quality of life.

1. Indications

The insertion of an anterior segment aqueous drainage device, as described by CPT® Code 0474T, is indicated for the treatment of the following conditions:

Mild to Moderate Primary Open-Angle Glaucoma - This condition is characterized by an increase in intraocular pressure due to the inadequate drainage of aqueous humor, which can lead to optic nerve damage and vision loss if left untreated.

2. Procedure

The procedure for the insertion of the anterior segment aqueous drainage device involves several critical steps to ensure proper placement and functionality of the device:

Step 1: Preparation and Anesthesia - The patient is prepared for the procedure, which may include administering local anesthesia to minimize discomfort during the insertion process. The eye is then prepped and draped in a sterile manner to maintain a clean surgical field.
Step 2: Paracentesis - A small incision, known as a paracentesis, is made in the eye to allow access to the anterior chamber. This step is crucial for the introduction of the applier and guidewire.
Step 3: Introduction of the Applier - Using a microscope for guidance, the handheld applier is introduced through the paracentesis. The applier is designed to facilitate the precise placement of the drainage device.
Step 4: Advancement of the Guidewire - The guidewire, which is attached to the device, is carefully advanced into the supraciliary space. The positioning is critical, as the device must be placed just posterior to the scleral spur at the iris root to function effectively.
Step 5: Deployment of the Device - Once the guidewire is in the correct position, the drainage device is delivered into the supraciliary space. The design of the device allows it to create a channel for aqueous fluid to flow out, thereby reducing intraocular pressure.
Step 6: Retraction of the Guidewire - After the device is successfully placed, the guidewire is retracted. The applier and guidewire are then removed from the anterior chamber, leaving the proximal retention ring of the device in the anterior chamber to maintain its position.

3. Post-Procedure

After the procedure, patients may be monitored for any immediate complications or adverse reactions. Post-operative care typically includes the use of prescribed eye drops to prevent infection and manage inflammation. Patients are advised to follow up with their ophthalmologist to assess the effectiveness of the device in controlling intraocular pressure and to ensure proper healing. Recovery time may vary, but patients are generally encouraged to avoid strenuous activities and to adhere to any specific post-operative instructions provided by their healthcare provider.

Short Descr	INSJ AQUEOUS DRG DEV IO RSVR
Medium Descr	INSJ ANT SEG AQUEOUS DRG DEV W/IO RSVR
Long Descr	Insertion of anterior segment aqueous drainage device, with creation of intraocular reservoir, internal approach, into the supraciliary space
Status Code	Carriers Price the Code
Global Days	XXX - Global Concept Does Not Apply
PC/TC Indicator (26, TC)	9 - Not Applicable
Multiple Procedures (51)	9 - Concept does not apply.
Bilateral Surgery (50)	9 - Concept does not apply.
Physician Supervisions	09 - Concept does not apply.
Assistant Surgeon (80, 82)	9 - Concept does not apply.
Co-Surgeons (62)	9 - Concept does not apply.
Team Surgery (66)	9 - Concept does not apply.
Diagnostic Imaging Family	99 - Concept Does Not Apply
APC Status Indicator	Non-Covered Service, not paid under OPPS
Berenson-Eggers TOS (BETOS)	none
MUE	2

59	Distinct procedural service: under certain circumstances, it may be necessary to indicate that a procedure or service was distinct or independent from other non-e/m services performed on the same day. modifier 59 is used to identify procedures/services, other than e/m services, that are not normally reported together, but are appropriate under the circumstances. documentation must support a different session, different procedure or surgery, different site or organ system, separate incision/excision, separate lesion, or separate injury (or area of injury in extensive injuries) not ordinarily encountered or performed on the same day by the same individual. however, when another already established modifier is appropriate it should be used rather than modifier 59. only if no more descriptive modifier is available, and the use of modifier 59 best explains the circumstances, should modifier 59 be used. note: modifier 59 should not be appended to an e/m service. to report a separate and distinct e/m service with a non-e/m service performed on the same date, see modifier 25.
LT	Left side (used to identify procedures performed on the left side of the body)
RT	Right side (used to identify procedures performed on the right side of the body)