Ophthalmology and Optometry Coding Alert

Practices performing a relatively new kind of corneal transplant procedure finally have a new code that describes it -- and now they can learn how much they can earn for the service.

In 2009, coders can report endothelial keratoplasty (EK) procedures with 65756 (Keratoplasty [corneal transplant]; endothelial). This code specifically applies to deep lamellar endothelial keratoplasty (DLEK) and Descemet's stripping endothelial

keratoplasty (DSEK -- sometimes known as DSAEK, for "Descemet's automated stripping endothelial keratoplasty"). These are new alternatives to the full-thickness corneal transplant, or penetrating keratoplasty (PK), procedures (65730-65755).

(See "Start Using 65756 for Endothelial Keratoplasty in January" in Ophthalmology Coding Alert, Vol. 11, No. 12.)

The bottom line: Now, with the release of the 2009 Physician Fee Schedule (see related story, pages 1 and 2), CMS has allotted 27.48 relative value units (RVUs) to 65756. Multiplying that by the 2009 conversion factor, 36.0666, determines a

national reimbursement rate: $991.11 (unadjusted for geography).This is in line with the other corneal transplant codes, which CMS values between $910 and $1026 nationally.

Another new code, the add-on code +65757 (Backbench preparation of corneal endothelial allograft prior to transplantation [List separately in addition to code for primary procedure]), which CPT directs coders to report with 65756, has no RVUs

assigned to it. The 2009 fee schedule notes that this code is carrier-priced, which means that individual carriers will establish RVUs and payment amounts, generally on an individual case basis following review of documentation such as an

operative report. You can download a copy of the Physician Fee Schedule Relative Value File at http://www.cms.hhs.gov/