CPT 0810T: Vitrectomy with Retinectomy and Subretinal Pharmacologic Injection - OpenPayer

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Summary & Overview

CPT 0810T: Vitrectomy with Retinectomy and Subretinal Pharmacologic Injection

CPT code 0810T denotes a combined posterior segment ophthalmic surgery: pars plana vitrectomy with retinectomy and subretinal pharmacologic injection. This code captures a complex, specialized procedure used to treat severe retinal conditions that require direct subretinal delivery of therapeutic agents and surgical manipulation of the retina. Nationally, the code is relevant for facilities managing advanced retinal disease and for payers that cover high-acuity ophthalmic surgery.

Key payers included in this analysis are Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise overview of clinical intent and typical service settings, payer coverage context, and operational considerations for claims processing. The publication summarizes benchmarks where available, outlines common coding and billing considerations tied to the procedure’s complexity, and highlights policy updates and reimbursement guidance affecting hospital outpatient departments and ambulatory surgery centers. Clinical context covers indications for vitrectomy with retinectomy and subretinal injection, care settings, and the procedural components that drive coding and payment.

AetnaBlue Cross Blue ShieldCigna HealthUnitedHealthcareMedicare0810TCPTvitrectomyretinectomysubretinal injectionophthalmologysurgical procedurehospital outpatientambulatory surgery center

Billing Code Overview

CPT code 0810T describes a surgical procedure in which the provider performs a pars plana vitrectomy to remove vitreous fluid and access the posterior segment of the eye, performs one or more retinal cuts (retinectomy), and injects a pharmacologic agent into the subretinal space.

Service type: Surgical retinal procedure combining vitrectomy, retinectomy, and subretinal pharmacologic injection.

Typical site of service: Hospital outpatient department or ambulatory surgery center, where posterior segment ocular surgery and intraocular drug administration are routinely performed.

Clinical & Coding Specifications

Clinical Context

A 68-year-old patient with a history of proliferative diabetic retinopathy presents with sudden visual distortion and progressive vision loss in the right eye. Examination and ocular imaging demonstrate a tractional retinal detachment with subretinal hemorrhage and persistent vitreous hemorrhage. The retinal surgeon schedules a pars plana vitrectomy with membrane peel and retinectomy and plans a subretinal injection of a pharmacologic agent to treat subretinal pathology and facilitate retinal reattachment.

Pre-procedure workflow includes informed consent, review of systemic anticoagulation and diabetes control, preoperative ocular imaging (OCT, B-scan ultrasound if media opacity), and anesthesia planning (retrobulbar block or general anesthesia for complex cases). Intraoperative steps include vitreous removal to access the posterior segment, endolaser as indicated, retinectomy (cutting the retina one or more times) to relieve traction, and targeted subretinal injection of the pharmacologic agent. Postoperative care involves topical antibiotics and steroids, positioning instructions, intraocular pressure monitoring, and scheduled follow-up including OCT and visual acuity assessment.

Coding Specifications

Modifier	Description	When to Use
`22`	Increased procedural services	Use when the vitrectomy with retinectomy and subretinal injection requires substantially greater work due to complexity or intraoperative complications.

Taxonomy Code	Specialty	Notes
207W00000X	Ophthalmology	Retinal surgeons and general ophthalmologists performing posterior segment surgery.
207WC0000X	Ophthalmic Plastic & Reconstructive Surgery	Occasionally involved for complex ocular surface or anterior segment adjuncts.
2080P0005X	Surgery - Ocular	Subspecialists focusing on surgical retina procedures and vitreoretinal surgery.
363LF0000X	Anesthesiology	Anesthesiologists providing monitored anesthesia care or general anesthesia for complex cases.
363LA2200X	Nurse Anesthetist (CRNA)	CRNAs providing anesthesia in ambulatory surgery centers and hospitals.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`H33.41`	Retinal detachment with traction, macula off, right eye	Tractional retinal detachment is an indication for vitrectomy with retinectomy and subretinal intervention.
`H43.1`	Vitreous hemorrhage	Dense vitreous hemorrhage often necessitates pars plana vitrectomy to clear media and address underlying retinal pathology.
`H35.81`	Proliferative diabetic retinopathy	Advanced diabetic retinopathy commonly leads to tractional detachments requiring vitrectomy and retinectomy.
`H33.4`	Traction detachment of retina	General code for tractional detachments indicating need for surgical intervention including retinectomy.
`H35.7`	Degeneration of macula and posterior pole	Subretinal injections may be indicated for submacular pathology encountered during posterior segment surgery.
`H35.6`	Macular hole	Complex or chronic macular holes associated with retinal pathology sometimes require vitrectomy and adjunctive subretinal procedures.
`H44.22`	Endophthalmitis, chronic	Severe intraocular infection may require vitrectomy with targeted subretinal or intraretinal therapy in selected cases.
`H26.9`	Unspecified cataract	Cataract may be addressed in the same operative session with combined procedures when access to posterior segment is required.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`67036`	Vitrectomy, mechanical, pars plana approach; with removal of vitreous to the retinal surface and membrane peeling when performed	Commonly performed before or instead of more extensive retinectomy; may be billed for vitrectomy components when retinectomy is not separately reportable.
`67110`	Repair of retinal detachment, with vitrectomy, when performed (involving cryotherapy, scleral buckling if performed separately)	May be reported for retinal detachment repair procedures that include vitrectomy; related when additional detachment repair techniques are used.
`67039`	Vitrectomy, pars plana; for removal of vitreous opacities (floaters), with or without adjunctive procedures	Used for diagnostic or limited vitrectomy procedures; less extensive than retinectomy procedures but related in workflow.
`67038`	Vitrectomy, mechanical, pars plana approach; with lensectomy, with or without intraocular lens implantation	Performed when combined cataract removal is needed during posterior segment surgery.
`65855`	Retinal endodiathermy; cryotherapy or laser retinopexy (peripheral)	Adjunctive retinal procedures such as endolaser or retinopexy performed during the same surgical session.
`67028`	Intravitreal injection of a pharmacologic agent	Performed in clinic or perioperative setting for intravitreal delivery; differs from subretinal injection but may be performed pre- or post-operatively.