Excision of Pterygium w/ amnoitic graft placement

[ocflower76]

Hello

I work at an ophthalmology ASC and a couple of our surgeons are insisting I use cpt 65780 (ocular surface reconstruction; amniotic membrane transplantation, multiple layers) when they perform a pterygium excision w/ placement of amniotic membrane graft. I believe this should be coded as 65426 (Excision or transposition of pterygium; with graft.)

I cannot find an LCD or NCD on the CMS website to help determine when 65780 is appropriate to bill so I'm hoping someone here can help.

Thanks in advance for any and all advice!!

Maggie

 

[Jamie Dezenzo]

CPT ASST

Year: 2009

Issue: June

Pages: 9&11

Title: Coding Communication

Ocular Surface Reconstruction

CPT code 65780, Ocular surface reconstruction; amniotic membrane transplantation, was first introduced in CPT codebook 2004. This code was designed for use in severe ocular surface disease in which there is a persistent corneal epithelial defect as well as stromal thinning due to neurotrophic keratopathy, corneal ulcer, or non-healing surgical wounds. This procedure involves debridement of the involved epithelium and stroma followed by the placement and suturing of one or more layers of amniotic membrane over the defect.

There is another surgical service that utilizes amniotic membrane that may lead to some confusion in coding. In some surgical procedures, amniotic membrane is used after the removal of a conjuctival growth known as pterygium graft. In those situations, the correct code to report is 65426, Excision or transposition of pterygium; with graft.

Hope this helps!

 

[ocflower76]

That was EXTREMELY helpful, thank you very much!!