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Ophthalmology and Optometry Coding Alert

Reader Questions:

Include Pterygium Removal in Reconstruction

Published on Mon Apr 04, 2005

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?

New Hampshire Subscriber 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.
 
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.
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