Wiki Pterygium excision/amniotic membrane transplantation-My doc excised

Lisa Bledsoe

True Blue
Greeley, Colorado
Best answers
My doc excised two pterygium from the same eye (one located toward the inner part "nasal" and one located toward the outer part "temporal"), and performed an amniotic membrane translplant to they eye. He coded: 65400, 65420, 68320, 65780 (no modifiers). Ins denied all but 65420. Per CCI edits all of the others are billable with mod -59. I think it should be coded 65420 and 65780 -59 only...(65400 states "except pterygium"). But since he removed TWO from the same eye, can I code 65420 twice (x2) or 65420, 65420 -59? Any help is greatly appreciated!
see page 4, right hand column of this link for info:

also....This 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

Hope this helps