Ophthalmology and Optometry Coding Alert

Also: Include graft prep in other corneal transplant codes.

If you've been frustrated by a lack of codes for the new endothelial keratoplasty (EK) procedures, take heart. Relief is coming in your 2009 CPT manual.

The new set of CPT codes, which take effect with dates of service starting Jan. 1 2009, introduces 65756 (Keratoplasty [corneal transplant]; endothelial).

This will allow coders to specifically describe the relatively new EK procedures, 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).

Instead of removing a "button" of tissue including the healthy stromal and surface epithelial layers, DLEK and DSEK surgeries only remove the diseased endothelial layer tissue, replacing it with a harvested graft, according to information found on the Web site www.dlek-dsek.com. Also, unlike the full-thickness PK or anterior lamellar transplants, EK procedures are sutureless.

Old way: Until January, your EK procedure coding will depend on your carrier's preference, says Maggie M. Mac, CMM, CPC, CPC-E/M, ICCE, consulting manager for Pershing, Yoakley, and Associates in Clearwater, Fla. For example, Part B carriers Trailblazer and Palmetto clarified that their providers should report DLEK/DSEK with 66999 (Unlisted procedure, anterior segment of eye). First Coast Service Options allows any code in the existing range of keratoplasty codes (65710-65755), while Highmark will only consider 65730-65755, based on the patient's lens status.

New way: Starting in January, you should report 65756 for all your ophthalmologist's EK procedures.

CMS has not yet released fee schedule information for 2009, so it's unclear how much you may expect in reimbursement for 65756.

Include Grafts and Topography in Most Transplants

There's more: CPT 2009 also introduces add-on code +65757 (Backbench preparation of corneal endothelial allograft prior to transplantation [List separately in addition to code for primary procedure]). A note directs coders to use +65757 "in conjunction with 65756."

Don't miss: The introduction to the keratoplasty codes will include additional information next year. CPT 2009 includes the statement that the "preparation of donor material is included for penetrating or anterior lamellar keratoplasty, but reported separately for endothelial keratoplasty."

The new instructions also caution you not to report 65710-65757 in conjunction with 92025 (Computerized corneal topography, unilateral or bilateral, with interpretation and report). Other new instructions forbid you from coding 65760 (Keratomileusis), 65765 (Keratophakia), 65767 (Epikeratoplasty), 65770 (Keratoprosthesis), or 65771 (Radial keratotomy) with 92025.

CPT 2009 also slightly revises the definitions of two existing corneal transplant codes. Code 65710 (Keratoplasty [corneal transplant]; anterior lamellar) adds the word "anterior" to the definition; and 65730 (... penetrating [except in aphakia or pseudoaphakia]) adds "pseudoaphakia."

You may notice several other alterations in the "Eye and Ocular Adnexa" section of your 2009 CPT handbook, most of them grammatical, such as changing the word "one" into the numeral "1." For example, in 2009, the definition of 67101 reads, "Repair of retinal detachment, 1 or more sessions ...."