Recurrent pterygium-bare-sclera technique

codedog

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Stuck on this one. Thinking 65420 would be right , but also thinking 65780? Not sure why ?

PREOPERATIVE DIAGNOSIS: Recurrent pterygium, left eye.

POSTOPERATIVE DIAGNOSIS: Recurrent pterygium, left eye.

PROCEDURE PERFORMED: Excision of the pterygium with bare-sclera technique with application of mitomycin.

ANESTHESIA: MAC.

COMPLICATIONS: None.

DESCRIPTION OF PROCEDURE: Informed consent was obtained from the patient and the patient was wheeled into the operating room. The left eye was prepped and draped in a standard fashion for this procedure. Lids and eyelashes were secured with the help of a lid speculum. Preservative-free lidocaine, one drop x3 was placed on the surface of the cornea and the conjunctiva. The patient was instructed to look towards the temporal side, exposing the nasal conjunctiva. The belly of the pterygium was held in 0.12 forceps and lidocaine mixed with epinephrine was injected into it. The head of the pterygium was dissected away from the cornea with the help of Tooke blade. The subconjunctival scar tissue was dissected followed by cautery. The conjunctiva itself was freed from the underlying scar tissue. A Weck cel sponge soaked in mitomycin-C at 0.4 mg/cc concentration was placed on the scar tissue for approximately 20 seconds and then removed. The dissected conjunctiva was sutured back without any tension to the surrounding sclera. The first 2 mm of the sclera from the limbal area was left bare in the hope that the pterygium will not go back towards the cornea. The patient was able to abduct and adduct completely at the end of the operation. The patient tolerated the procedure well. TobraDex ointment was placed in the eye at the end of the operation followed by eye patch. The patient was transferred to the recovery room without any other complications.
 

Jamie Dezenzo

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Year: 2009 CPT ASST

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.
 
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