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Amniotic Membrane Graft

coderguy1939

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Doctor did an exicision of a pterygium (65420) with an amniotic membrane graft (65780). This is a Medicare patient and CCI edits indicate 65780 as bundled with 65420 but modifier allowed. V2790 also applies for the graft material. Would it be appropriate to bill all three?
 

elenax

Expert
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337
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Stuart
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I have billed the three codes at the same time; I just make sure my operative report can support overriding the bundled code with the '59' modifier.

Hope this helps!
 

coderguy1939

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Thank you both for replying. 65426 does include an autograft, but amniotic tissue is engineered tissue. The op report clearly indicates use of the amniotic graft, so if I understand you correctly I can add modifier 59 (I work for an ASC) and bill out 65420 with 65780. I believe with Medicare you need to submit an invoice for the tissue--the same as corneal grafts.

Thanks again.
 

mbort

True Blue
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2,338
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ENGLEWOOD/DENVER
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also see below which is from the AAOO (American Academy of Opthamology)

Please note: Inappropriate use of 65780, ocular surface reconstruction; AMT, for placing ProKera or for AMT as an add-on to pterygium surgery, another potential area for abuse, might result in reevaluation of the code. The danger of such a reassessment is that the code could be reduced to a value that is commensurate with fitting of a bandage contact lens.

—David B. Glasser, MD, member of the Academy Health Policy Committee
 

coderguy1939

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Thanks for the information. This certainly is a procedure
that has the potential of causing a headache for coders.
 
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