jstevens28
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I have come across a coding issue that really has me very puzzled. Our surgeons want us to bill 65780 (Ocular surface reconstruction; amniotic membrane transplantation, multiple layers) for a pterygium excison with AMT. They are using the Ambio5 multilayer AMT for this procedure. My issue with this is that I understood the correct billing was 65426 (Excision or transposition of pterygium; with graft) since the code specifies a graft and per the information I have found on sites like find-a-code state: Alternatively, an allograft, such as an amniotic membrane graft obtained from a tissue bank, may be used. The graft is sutured onto the conjunctiva or secured using fibrin tissue glue. My understanding was that the 65780 (Ocular surface reconstruction; amniotic membrane transplantation, multiple layers) was used more for burns or damage to the eye or possibly if a repeat pteryguim is removed which would require a more extensive removal. The usual op note for this reads as such:
DESCRIPTION OF PROCEDURE: After a mixture of Xylocaine jelly with Vigamox was placed on the patient?s ocular surface, the eye was prepped and draped in the usual sterile fashion. A Lieberman lid speculum was placed and then Westcott scissors and 0.12 forceps were used to carefully dissect the fibrovascular growth off the corneal surface. A crescent blade was then used to smooth the corneal surface. The body of the pterygium was bluntly dissected from the bulbar conjunctiva and the sclera. Westcott scissors and forceps were used to remove the body of the pterygium. Hemostasis was obtained with cautery. The corneal/conjunctival defect was measured with calipers. The Amniotic membrane was cut with scissors. Tisseel glue was used to secure the amniotic membrane to the sclera and cornea. A wet Weck-cel sponge was then used to measure the stability of the amniotic membrane, which was secure in position. The lid speculum was removed. The drapes were removed. Tobradex ointment was placed into the eye and a sterile pressure patch was placed over the eye. The patient was transferred to recovery room in good condition.
Any help and clarification on this would be helpful.
DESCRIPTION OF PROCEDURE: After a mixture of Xylocaine jelly with Vigamox was placed on the patient?s ocular surface, the eye was prepped and draped in the usual sterile fashion. A Lieberman lid speculum was placed and then Westcott scissors and 0.12 forceps were used to carefully dissect the fibrovascular growth off the corneal surface. A crescent blade was then used to smooth the corneal surface. The body of the pterygium was bluntly dissected from the bulbar conjunctiva and the sclera. Westcott scissors and forceps were used to remove the body of the pterygium. Hemostasis was obtained with cautery. The corneal/conjunctival defect was measured with calipers. The Amniotic membrane was cut with scissors. Tisseel glue was used to secure the amniotic membrane to the sclera and cornea. A wet Weck-cel sponge was then used to measure the stability of the amniotic membrane, which was secure in position. The lid speculum was removed. The drapes were removed. Tobradex ointment was placed into the eye and a sterile pressure patch was placed over the eye. The patient was transferred to recovery room in good condition.
Any help and clarification on this would be helpful.