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Ophthalmology and Optometry Coding Alert

Reader Questions:

Opt for 65780 for Amniotic Membrane Graft

Published on Tue Mar 28, 2006

Question: The ophthalmologist wants to perform a pterygium excision with anmiotic membrane graft. A rep told us to report 65780 and V2790 rather than 65426. Is that correct?


Georgia Subscriber
Answer: Yes. If the ophthalmologist is using an amniotic membrane graft (such as AmnioGraft), report 65780 (Ocular surface reconstruction; amniotic membrane transplantation).

Although 65426 (Excision or transposition of pterygium; with graft) may also generally describe the procedure, CPT introduced 65780-65782 in 2004 specifically to describe "ocular surface reconstruction utilizing stem cells obtained from living or non-living donor grafts." Medicare will also reimburse more for 65780 (20.99 facility RVUs) than for 65426 (10.42 facility RVUs).

The facility should report HCPCS code V2790 (Amniotic membrane for surgical reconstruction, per procedure) for the supply of the donor tissue.
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