Wiki Amniotic Membrane Graft

[coderguy1939]

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]

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!

 

[mbort]

65426 includes the graft and is more appropriate with the V2790.

 

[coderguy1939]

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]

please see page 4 of this link, the right hand column

http://www.oasismedical.com/res_products/pdf/AcelagraftMonographCorcoranConsultingSep07.pdf

 

[mbort]

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]

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