Results 1 to 3 of 3

Pterygium excision/amniotic membrane transplantation-My doc excised

  1. #1
    Greeley, Colorado
    Red face Pterygium excision/amniotic membrane transplantation-My doc excised
    Medical Coding Books
    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!
    Lisa Bledsoe, CPC, CPMA

  2. #2
    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

  3. #3
    Greeley, Colorado
    Thumbs up
    Mary - you are an angel!! Thanks so much!
    Lisa Bledsoe, CPC, CPMA

Similar Threads

  1. Need help with Clarix amniotic membrane graft
    By lphillips in forum Orthopaedics
    Replies: 0
    Last Post: 12-24-2014, 11:42 AM
  2. Pterygium excision/amniotic membrane transplantation
    By kobusk in forum Ophthalmology/Optometry
    Replies: 1
    Last Post: 03-21-2011, 10:19 AM
  3. Assignment of CPT code when using amniotic membrane for a pterygium surgery
    By calderonmark in forum Ophthalmology/Optometry
    Replies: 1
    Last Post: 05-21-2010, 08:53 AM
  4. Amniotic membrane
    By codedog in forum Outpatient Facilities
    Replies: 2
    Last Post: 02-16-2009, 08:07 AM
  5. Amniotic Membrane Graft
    By coderguy1939 in forum Outpatient Facilities
    Replies: 6
    Last Post: 06-06-2008, 09:58 PM

Posting Permissions

  • You may not post new threads
  • You may not post replies
  • You may not post attachments
  • You may not edit your posts
Enjoying Our Forums?

AAPC forums are a benefit of membership. Joining AAPC grants you unlimited access, allowing you to post questions and participate with our community of over 150,000 professionals.

Join Now Continue Reading Without Full Access

Already a Member?


Close Message

In addition to full participation on AAPC forums, as a member you will be able to:

  • Access to the largest healthcare job database in the world.
  • Join over 150,000 members of the healthcare network in the world.
  • Be a part of an industry leading organization that drives the business side of healthcare.
  • Save anywhere from 10%-50% with exclusive member discounts on courses, books, study materials, and conferences.
  • Access to discounts at hundreds of restaurants, travel destinations, retail stores, and service providers. AAPC members also have opportunities to save on heath, life, and liability insurance.
  • Become a member of a local chapter and attend regular meetings.