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65779 vs 66999

codedog

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Can I bill 65779 placement of amniotic membrane (with 66999- unlisted code for use of glue) and( suture 65779 _according to opeative report

PREOPERATIVE DIAGNOSIS: Recurrent advanced pterygium, left eye.

POSTOPERATIVE DIAGNOSIS: Recurrent advanced pterygium, left eye.

PROCEDURE PERFORMED: Pterygium excision with mitomycin and ocular surface reconstruction with amniotic membrane graft, left eye.

ANESTHESIA: MAC, retrobulbar.

PROCEDURE IN DETAIL: After informed consent and proper laboratory examination was performed, the patient was brought to the OR and placed in a supine position. After a time-out was done to confirm the correct patient and surgical site, the patient underwent a modified van Lint lid block and retrobulbar anesthesia using equal mixture of 2% Xylocaine and 0.75% of Marcaine. The left eye was then prepped and draped in the usual sterile ophthalmic fashion. A lid speculum was placed in the patient’s left eye. Gentian blue marking pen was used to demarcate the body of the pterygium. The head of the pterygium was removed using 0.12 forceps and Weck-Cel spears. The body of pterygium was resected using Westcott scissors. Hemostasis was obtained using wet field bipolar cautery. The corneal surface was smoothed out using 5-mm diamond bur while BSS solution was continuously dripped on the corneal surface. Mitomycin C and 0.4 mg/cc were applied to the bare sclera for two minutes and was copiously irrigated with BSS solution. After the dimension of the bare sclera was measured, the cryopreserved amniotic graft was cut to the appropriate size and peeled off from the nitrocellulose paper and was laid on the corneal surface. Tisseel glue was placed on the bare sclera followed by the transfer of amniotic graft to the recipient site. The graft was stretched and flattened with two forceps and smoothed out with a muscle hook. The graft was then tucked under the conjunctival edge and the conjunctiva was sealed over the graft with fibrin glue. Four interrupted 9-0 Vicryl sutures were placed at four cardinal positions to secure the donor graft to the recipient conjunctiva. At the end of the procedure one drop of prednisolone acetate, Ciloxan, and Tobradex ointment were instilled in the patient’s left eye. After lid speculum was removed, the eye was then patched and secured in the usual fashion. The patient tolerated the procedure well and was transported to the recovery room in a stable condition.
 
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