Wiki Eye Practice 65780 & 65420

[sjminfl]

I work for a billing company that supports an Eye practice.
We have been submitting procedures as follows:

65780 LT
65420 LT 51


65780: Ocular reconst, transplant
65420 Excision or transposition of pterygium; without graft

The 65780 has been denied with the M80 remark (Not covered when performed during the same session/date as a previously processed service for the patient.)

Can someone help?

 

[lrcarver]

We have a coding software for surgeries and when I put the two codes in it states that 65420 includes 65780. If you can justify the modifier it needs to be placed on the 65780. Please see the description below from the bundling software.

Unbundling Allowed With Appropriate Modifier
Code 65780 (RVU: 20.36) is included in 65420 (RVU: 8.62). 65780 (RVU: 20.36) may be unbundled from 65420 (RVU: 8.62) if you can justify the use of an appropriate modifier. If you are unable to justify the use of a modifier, you may only bill 65420 (RVU: 8.62). If you bill both, 65780 (RVU: 20.36) should receive the modifier.


Thanks,

Lenore Carver, CPC

 

[sjminfl]

Thank you very much.


Steve

 

[codedog]

now can I CODE 65780 AND 65420 WITH THIS ?


POSTOPERATIVE DIAGNOSIS: Primary pterygium, left eye.
ERATIONS: 1. Pterygium excision with mitomycin-C, left eye. 2. Ocular surface reconstruction with amnion graft, left eye.

.
PROCEDURE IN DETAIL:
After informed consent and proper laboratory examination was performed, the patient was brought to the OR and placed in the supine position. After a modified van Lint lid block and retrobulbar anesthesia were performed using equal mixture of 2% Xylocaine and 0.75% of Marcaine, the eye was prepped and draped in the usual sterile ophthalmic fashion. 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 avulsed using 0.12 forceps and Weck-Cel spears. The body of the pterygium was resected using Westcott scissors. Hemostasis was obtained using Weck-Cel bipolar cautery. The corneal surface was smoothed out using 5 mm diamond burr, while BSS solution was continuously dripped on the corneal surface. Mitomycin-C 0.4 mg/cc were applied to the bare sclera over two minutes and was thoroughly and copiously irrigated with BSS solution. After the dimension of the bare sclera was measured, the Cryopreserved Amnion Graft was cut to the appropriate size and peeled off from the nitrocellulose paper and was laid on the corneal surface. Weck-Cel spears were used to dry the bare sclera followed by placement of Tisseel glue and transfer of amnion graft to the recipient site. The graft was stretched and flattened with two forceps and smoothed out using a muscle hook. The graft was then cut under the conjunctival edge and the conjunctiva was peeled over the graft with Tisseel glue. Four interrupted 9-0 Vicryl sutures on a BV needle 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. 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 stable condition.