Ophthalmology and Optometry Coding Alert
Include Pterygium Removal in Reconstruction
Question: The ophthalmologist performed a pterygium excision with graft, using an amniotic membrane graft. However, I'm not sure which code to report - 65426 describes the pterygium excision, but 65780 describes the membrane transplantation. Can I report both? Answer: Report 65780 (Ocular surface reconstruction; amniotic membrane transplantation) alone. That code is bundled with 65426 (Excision or transposition of pterygium; with graft) by the National Correct Coding Initiative. If you attempt to bill both codes separately, only 65426 will be paid. In this case, the pterygium removal is part of the ocular surface reconstruction.
New Hampshire Subscriber
For the graft itself, you can report HCPCS code V2790 (Amniotic membrane for surgical reconstruction, per procedure). Your local carrier has jurisdiction over whether it will reimburse for this code.
Ophthalmology and Optometry Coding Alert
- Seal Off Leaky Reimbursement for Diabetic Retinopathy Treatments
Key: The right ICD-9 codes and modifiers can bring your practice an extra $900 for [...] - Use 2 Diabetes Codes for Sweet ICD-9 Compliance
This diagnosis coding trick can help you avoid denials
You've found the correct ICD-9 code for [...] - Reporting Multiple Laser Sessions Only Once? Think Again
2 different kinds of treatments mean 2 separately billable procedures Coding focal laser or panretinal photocoagulation [...] - You Be the Coder:
Topography for Post-LASIK Cataracts
Question: A patient who has had LASIK surgery now has cataracts. One of our ophthalmologists [...] - Treat Detached Retina as Unrelated to Cataract Surgery
DRs and dislocated IOLs are dangerous - for coders and patients Last month, we explained [...] - Reader Questions:
Unwrinkle Nursing Facility POS Codes
Question: Our ophthalmologists sometimes go to see patients in nursing homes. What criteria should I [...] - Reader Questions:
Don't Kid Around With Pediatric Consults
Question: We have a pediatric ophthalmologist who has started to see patients for second opinions [...] - Reader Questions:
Sew Up Wound Leak Repair Coding
Question: My ophthalmologist returned to the OR this morning to repair a wound leak following [...] - Reader Questions:
Include Pterygium Removal in Reconstruction
Question: The ophthalmologist performed a pterygium excision with graft, using an amniotic membrane graft. However, [...] - Reader Questions:
Don't Modify Nonconclusive HRT Claim
Question: How should I code for a nonconclusive HRT? One of our patients had one [...] - Reader Questions:
Downcode E/M to Documented Components
Question: When we determine an E/M code, the chart we use to select the level [...] - Reader Questions:
Report 2nd Doctor's Post-Op Care With -78
Question: If Ophthalmologist 2 in our group practice provides post-op care for a patient whom [...] - Clarification:
Report Reconstruction, Not Excision, if Only 1 Code Allowed
Two articles in recent issues of Ophthalmology Coding Alert give conflicting advice on reporting pterygium [...] - Clarification:
Report Reconstruction, Not Excision, if Only 1 Code Allowed
Two articles in recent issues of Ophthalmology Coding Alert give conflicting advice on reporting pterygium [...]
