Wiki Dislocated graft-repositioned

coachlang3

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Hi everyone!! Very new to ophthalmology coding and got a new scenario. Did some research and coming up a little short in being able to decipher which code to go with.

Patient had a cornel graft performed and then the graft became dislocated. Provider is looking at 66250 (Revision or repair of operative wound of anterior segment, any type, early or late, major or minor procedure) but I'm wondering if 67560 (Orbital implant (implant outside muscle cone); removal or revision) is better.

Here is the procedure text:

A lid speculum was inserted into the patient's eye. Thereafter, the left cornea was evaluated. The corneal epithelium was removed with a 64-blade, since the view of the anterior chamber was extremely hazy due to corneal edema. An additional paracentesis site was then carried out at about 4 o'clock position for better manipulating of the graft. Thereafter with the help of small air bubble very close to the iris, the graft was floated into the anterior chamber. Additional BSS was added into the anterior chamber and with the help of a reverse Sinskey hook, the graft had to be maneuvered in order to bring it into the centration position. Thereafter, a complete fill of air was placed in the anterior chamber for about 20 minutes and 1% Cyclogyl was placed on the eye. A 10-0 nylon suture was taken through the superior paracentesis site (paracentesis site of the original DSAEK surgery). The knots were cut short and buried inside the wound. The graft was well centered at the conclusion of the case. The cornea was stroked gently to remove the interface fluid, especially through the venting incisions (venting incisions were done during the original DSAEK procedure). At the end of the 20 minutes, the air was partially removed using BSS. All the wounds were checked for leaks, none was found.

Thanks for any and all feedback.
 
In my office, we use "coding coach". It is a tool that AAO (American Academy of Ophthalmology) maintains. When I looked up these 2 codes, it appears that 66250 would be more appropriate for this procedure. It is specific to a DSAEK procedure.
The doctor I have billed for in the past does occuloplastics and has used 67560 to strenghten the orbital floor. When I look at the anatomy of the eye, the muscle cone is attached to the exterior of the eyeball altogether, having nothng to do with the cornea.

I could be wrong. I'm not the most experienced with this speciality.
 
I worked in a cornea practice for many years. CPT 66250 is the correct code for this procedure. If it was just an air bubble, it would be 66020. Since it was resutured/repostitioned, CPT 66250 should be billed.
 
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