Vitreoretinal Disease & Surgery Coding Fest 2017 Vitreoretinal Surgery & Disease University of FL College of Medicine ADULT RETINA Medical Retina Surgical Retina Age Related Vascular Disease Vascular Disease Anatomical Disease Medical Retina Office Based Practice 1
Common Abbreviations in Medical Retina VMT Vitreomacular Traction BRVO/CRVO/HRVO Branch/Central/Hemi Retinal Vein Occlusion BRAO/CRAO Branch/Central Retinal Artery Occlusion OIS Ocular Ischemic Syndrome PDR Proliferative Diabetic Retinopathy NDPR Nonproliferative Diabetic Retinopathy ARMD Age Related Macular Degeneration CNV/CNVM Choroidal Neovascular Membrane PVD Posterior Vitreous Detachment RRD Rhegmatogenous Retinal Detachment TRD Tractional Retinal Detachment SCR Sickle Cell Retinopathy ROP Retinopathy of Prematurity Choroidal Nevus HRVO Hemi-Retinal Vein Occlusion A blocked retinal vein causing retinal hemorrhaging and lack of blood flow Eye stroke 2
BRAO Branch Retinal Artery Occlusion A blocked retinal artery causing lack of blood flow and retinal swelling Eye stroke ARMD (Wet Macular Degeneration) Age Related Bleeding under the Retina Candidate for Treatment with Anti-VEGF (IVA) Common Abbreviations/Shorthand in Medical Retina Procedures PRP Pan retinal photocoagulation Focal Focus laser in the a section of retina Retinopexy laser usually around a retinal tear LIO Laser Indirect Ophthalmoloscopy IVA/IVB/IVT Intravitreal Avastin/Bevacizumab/Triamcinolo ne IVL/IVE Intravitreal Lucentis/Eylea STK Subtenon s Kenolog Vit T/I Vitreous Tap & Inject 3
Pan-Retinal Photocoagulation (PRP) CPT 67228 Surgical Retina Operating Room Based Practice Common Abbreviations in Surgical Retina PPV Pars Plana Vitrectomy ERM/EMM Epiretinal/Epimacular Membrane ILM Internal Limiting Membrane MEL/ML Membrane Lysis SDEM/DEM Scissors Delamination of Epiretinal Membrane/Tissue EL/EPC Endolaser/Endophotocoagulation PPL Pars Plana Lensectomy SSIOL Scleral Sutured Intraocular Lens ISIOL Iris Sutured Intraocular Lens Afx Air/Fluid Exchange FGx Fluid/Gas Exchange SO Silicone Oil 4
Jules Gonin(1870-1935) First successful method of vitreoretinal surgical treatment 1919: Ignipuncture Modified Custodis Procedure: Lincoff & Co-workers 1967 (Silicone) C. Haruta published his closed vitrectomy technique in 1959 Robert Machamer (1933-2009) Birth of Modern Vitreoretinal Surgery April 1970, Miami FL Chairman, Duke Dept of Ophthalmology 1978 5
Pars Plana Vitrectomy (PPV) Anatomical Approach Removal of Vitreous Peyman: Wide angle cutter Peyman: Vitrophage guillotine-like cutter Early 70s Vitreous Cutters O Malley guillotine-like cutter Kloti Vitreous Stripper 1974 Grieshaber-Schepens Nibbler 20g: O Malley & Heintz Peyman: 23g Vitrectomy Charles: 25g Disposable Microvitrector, Delamination, Modern Machines 6
EMM (Macular Pucker) Vitreomacular Traction (VMT) Macular Hole Stage 3 7
Summary Points So many Acronyms! Retina is a Broad Disciple: - Medical & Surgical - Know the ABCs, and then you can understand the language of Retina Retinal Disease can be a first manifestation of uncontrolled systemic disease Retinal Disease patients can have great outcomes if treated in a timely fashion and with a systematic approach POST - TEST 8
Question 1 Which of the following best describes the Acronym PPV? A. Pars PlicataVitrectomy B. Pars Plana Vitrectomy C. Part Plana Vitrectomy D. This is not an acryonym common in Retina Which of the following is the correct regarding this condition? A. Focal Retina Laser (Focal) B. Pan Retinal photocoagulation (PRP) C. Rhegmatogenous Retinal Detachment (RRD) D. Clinically significant macular edema (CSME) Question 3 Which of the following is an eye cancer found in the eye? A. Choroidal Nevus B. Choroidal Squamous Cell Carcinoma C. Choroidal Melanoma D. Choridal Basal Cell Carcinoma 9
Which of the following medical conditions can be diagnosed by an eye exam? A. Osteoarthritis B. Mitral Valve Prolapse C. Gallbladder Disease D. Hypertension Question 5 Which of the following is MOST CORRECT regarding relevance of information regarding a retinal detachment? A. Retinal detachments cause blindness and cannot be corrected B. Prognosis regarding retinal detachments are time dependent C. Retinal detachments are a part of normal aging and do not have to be addressed D. Retinal detachments are typically associated with trauma E. None of the above A 75M walks into the clinic with the exam as shown. What is the correct method of management? A. Treatment with IVA, IVL or IVE B. Observation C. Treatment with cataract surgery D. Removal of the eye (enucleation) 10
Question 7 Laser retinopexy is a type of treatment for what condition? A. CSME B. Endophthalmitis C. Retinal Tear D. Choroidal Nevus 11