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Assignment of CPT code when using amniotic membrane for a pterygium surgery

  1. Red face Assignment of CPT code when using amniotic membrane for a pterygium surgery
    Medical Coding Books
    I need assistance regarding the correct assignment of a CPT code when using amniotic membrane for a pterygium surgery.

    For the past several years CPT code 65780 has been reported in Ambulatory Surgery Centers to CMS (Medicare) and Private Payer insurers for the use of amniotic membranes during pterygium surgery. But lately there has been some concern by ophthalmologists to report this code 65780 when some folks say that 65426 is the more accurate code. I need to find out which is the best code to use.

    CPT procedure code 65780 with AmbioDry 2/5 in a pterygium procedure.

    1) CPT -4 Code Descriptor:
    CPT 65780- Ocular surface reconstruction; amniotic membrane transplantation

    CPT 65426- Excision or transposition of pterygium; with graft

  2. Default
    We use the 65426 when it's pterygium.
    We use the 65780 when the physician uses AMT graft for any other problem (eg chemical burn).

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