# Revision astigmatism keratotomy



## mbort (Jul 30, 2008)

ok..I'm at a loss.  Anyone have any ideas for me??

PREOPERATIVE DIAGNOSIS:
1.	Surgically-induced astigmatism in patient's left eye.

POSTOPERATIVE DIAGNOSIS:
1.	Surgically-induced astigmatism in patient's left eye.

OPERATION PERFORMED:
1.	Resuturing of the astigmatic keratotomy.

ANESTHESIA:  Modified anesthesia care with topical anesthesia.

ANESTHESIOLOGIST:  

DESCRIPTION OF PROCEDURE:
The patient was status post cataract surgery with astigmatic keratotomy correction for oblique astigmatism.  The correction was done with diamond blade and this correction turned out to be overly corrected, which left the patient with a 3.5 diopters of regular astigmatism at the steep axis of 22.  After the careful observation for more than two months, it was noted that the overcorrection is causing to regress.  After risks, benefits, and alternatives were discussed, the patient agreed to have revision of astigmatic keratotomy.  The patient was escorted to operating room.  A lid speculum was placed in the eye.  The eye was prepped and draped in usual sterile fashion for intraocular surgery.  A 10-0 nylon suture was used in interrupted fashion to resuture the two astigmatic keratotomy incisions.  Each arcuate incision was decompressed with three interrupted sutures and they were tied appropriately and the knots were rotated to embed the knots inside the corneal stroma.  After a total of six interrupted sutures were placed, one drop of Vigamox was placed on the patient's cornea.  A metal shield was applied to the eye


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## amitjoshi4 (Jul 30, 2008)

Hello,



mbort said:


> ok..I'm at a loss. Anyone have any ideas for me??
> 
> PREOPERATIVE DIAGNOSIS:
> 1.    Surgically-induced astigmatism in patient's left eye.
> ...


 
In my opinion this qualifies for 65772. Being a surgically induced astigmatism this is the best code i can see. Look per CDR also 

The cornea is one of several structures in the eye that contributes to refraction. Altering the shape of the cornea therefore alters visual acuity. When a previous surgery (e.g., for insertion of an intraocular lens or a corneal procedure) results in astigmatism, the physician at a later date returns the patient to the operating room to correct the problem. *The physician retracts the patient's eyelids with an ocular speculum. In corneal relaxing (65772), an "X" cut is made on the cornea to repair the error. Slices along the "X" are removed and its edges are sutured*. In the corneal wedge resection (65775), a wedge is cut from the cornea and the edges sutured. The resulting change in the corneal curvature alters the refractive properties of the cornea to correct the preexisting refractive error. The speculum is removed. Antibiotic ointment and a pressure patch may be applied.

The operative report scenario matched with the CDR. Your opinion on this ?

Regards.


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## thythaot (Jul 31, 2008)

*Cpc-a*

I don't think code 65772 is a right choice, because in general, wedge resection is used to correct large amount of astigmatism while relaxing incisions are used for smaller corrections. Otherwise, the corneal wedge resection to steepen the flat meridian and relaxing incisions to flatten the steep meridian. Average reduction in corneal astigmatism was greater for the wedge resection (ten cases)

In this case, the procedure was using multiple sutures and this correction was done with diamond blade. Also, wedge resection is the technique that is readily capable of correcting up to 20 D of astigmatism. In the record said : “astigmatism at the steep axis of 22”. All the details can prove that is corneal wedge resection for correction of surgically induce astigmatism. 
The correct code is 65775-LT.


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## mbort (Jul 31, 2008)

to me, he is just indicating that the "diamond blade" was used originally not on this particular case.  To me it appears that he only sutured the previous over correction.  I dont beleive any incisions were made during this procedure he is just referring to what he is repairing.

Any more thoughts?


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