# bleb revision with amniotic membrane  graft



## codedog (Dec 16, 2010)

Patient had a bleb revision with amniotic membrane graft.  IT is  medicare patient.
should i use 66185  ?
,someone told me to use 65782 to cover the cost of graft, would anyone use one or either of these code /-thanks trent 

 patient unnderwent a bleb revision with amniotic membrane graft in the recent past.  Unfortunately, the conjunctivae regressed a little bit, exposing the underlying amniotic membrane, which appears to have melted causing the cystic bleb leak to reappear.  There was a perfuse leak and so the patient was brought back for repair of the leaking cystic bleb.
A 7-0 Vicryl stay suture was placed through the superior nasal limbus.  The eye was rotated inferiorly.  A limbal peritomy was performed on either side of the cystic bleb.  Sub-Tenon's preservative-free lidocaine injection was given followed by posterior dissection in the same plane.  Adequate hemostasis was achieved with the help of underwater cautery.  The conjunctiva was stretched and relaxations were performed to the superior fornix.  After making sure there was adequate conjunctiva to cover the bleb, the cystic portion of the bleb was de-epithelialized with a dry Weck-cel sponge.  Then it was __ribbed with a double-folded amniotic membrane graft which was secured to the surrounding episclera with the help of figure of eight 10-0 nylon sutures.  Then a corneal limbal incision was performed.  The amniotic membrane graft along with the conjunctival edge was then sutured into the corneal groove that was created with the help of interrupted 10-0 nylon sutures.  

The patient tolerated the procedure well.  At the end of the procedure the cystic bleb was completely covered.  The graft appeared to be holding in place and there was no tension on the conjunctivae.


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## elenax (Dec 20, 2010)

I Would go with 65780.


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## codedog (Dec 22, 2010)

can i use 65780 with 66250 or just 65780 alone ?


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## elenax (Dec 23, 2010)

I would go with the 65780 only.


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