Ace Your Corneal Transplant Coding With These Guidelines
Find out the differences between DSEK, DMEK, and DALK. Corneal transplantation has evolved dramatically over the past two decades. With the shift from full-thickness penetrating keratoplasty (PKP) to selective lamellar techniques such as endothelial keratoplasty (EK), coding complexity has increased alongside surgical sophistication. For ophthalmology billing teams, understanding the nuances of CPT® coding for corneal transplants is essential to ensure accurate reimbursement and compliance. Read on to learn how to code corneal transplant procedures. Pick out the Correct PKP Codes The CPT® code set includes the following PKP codes: A PKP procedure involves full-thickness replacement of the cornea. You’ll select the CPT® code depending on the patient’s lens status at the time of surgery, such as: Don’t miss: Accurate documentation of lens status is critical. Coding errors often arise when operative reports fail to clearly state whether the patient is phakic, pseudophakic, or aphakic. These codes also include donor tissue preparation when performed by the surgeon. However, if cataract extraction or IOL insertion is performed during the same operative session, separate coding may be appropriate, depending on payer policy and clinical circumstances. Determine the Endothelial Keratoplasty Approach Selective lamellar techniques replace only the diseased posterior layers of the cornea. The most common approaches are: For any of these approaches, you would report 65756 (… endothelial). This code encompasses DSEK, DSAEK, and DMEK; it does not differentiate among techniques. To support 65756, the operative note must clearly state that the provider performed an EK. Documentation should describe removal of host Descemet membrane and insertion of donor posterior lamella. If pre-cut tissue is used from an eye bank, the surgeon’s documentation should reflect handling and insertion but not tissue preparation unless the surgeon also prepared the tissue. Common pitfalls: Do not report 65756 with PKP codes in the same eye. Also, avoid unbundling steps inherent to the EK procedure (for example, air bubble placement for graft adherence). Be sure to track the global period for 65756 (90 days) correctly. Use 65710 for Anterior Lamellar Keratoplasty Assign 65710 (… anterior lamellar) for anterior lamellar keratoplasty procedures, including deep anterior lamellar keratoplasty (DALK), where only anterior corneal layers are replaced. Unlike EK, lamellar keratoplasty under 65710 typically addresses stromal pathology while preserving the host endothelium. Double check: DALK documentation should include: Clear operative language differentiating anterior lamellar from penetrating keratoplasty is crucial to prevent downcoding or denial. Don’t Forget About the Keratoprosthesis Code Use 65770 (Keratoprosthesis) when the surgeon implants an artificial cornea, such as a Boston keratoprosthesis, which is typically reserved for patients who are poor candidates for traditional grafting. Documentation must reflect the indication for prosthesis, device implantation, and any associated surgical steps. Given the complexity and higher reimbursement associated with keratoprosthesis, payers may require additional documentation or prior authorization. Remember Add-On and Related Coding Considerations In most cases, donor tissue handling and preparation performed by the operating surgeon is included in the keratoplasty code. However, if the tissue is prepared by an eye bank, then the surgeon may not separately bill that service. Corneal transplants are frequently performed alongside other procedures, such as cataract extractions, IOL repositioning or exchange, anterior vitrectomy, or glaucoma procedures. If the other procedure is bundled with the corneal transplant under National Correct Coding Initiative (NCCI) rules, check if a modifier, such as 59 (Distinct procedural service) or XS (Separate structure, a service that is distinct because it was performed on a separate organ/structure), is appropriate to report the two codes separately. Most keratoplasty codes carry a 90-day global period. Coders should monitor postoperative visits and identify complications that may justify separate reporting (for example, with modifier 78, [Unplanned return to the operating/procedure room by the same physician or other qualified health care professional following initial procedure for a related procedure during the postoperative period]). Be sure to distinguish routine postoperative care from unrelated services that may require modifier 24 (Unrelated evaluation and management service by the same physician or other qualified health care professional during a postoperative period). Align Your ICD-10 Codes Medical necessity for the corneal transplant procedure must be backed up by the diagnosis code. Some ICD-10-CM codes that demonstrate medical necessity are: Important: Once you have found the correct code series, make sure you are reporting all of the necessary characters. Many ocular diagnosis codes require several characters to describe whether the left, right, or both eyes are affected. Example: A patient presents with corneal transplant failure. Depending on which eye (or both) is affected, you would report one of the following codes: Jerry Salley, BA, MFA, Contributing Writer
