Wiki cpt 65426 with 65779 for amnio graft

[leren44]

Please help!
I have posted this question before but i need someone provide some back up.

I have a surgeon that insists that I code a removal of pterygium with graft using amniotic tissue as 65420 with 65779. His reasoning is that reimbursement received for 65779 will help absorb some of the cost for the amniotic graft. He has even emailed me documentation he had from "Savvy Coder" that states: "When performed in an ASC, submit 65420- eye modifier first followed by 65779-eye modifier." The person giving that advise is a CPC and Academy Coding Specialist.

I am the coder and biller for an ASC. I have not and will not code a pterygium removal with amniotic graft unless I am proven to be wrong that the correct coding for this procedure is 65426-eye modifier with V2790. I have read that the meaningful use of 65778 and 65779 is to promote wound healing in cases due to acute accident situations or disease processes... not for a pterygium removal. But i'm unable to locate that documentation again. Please! Can anyone help?

Thanks!

 

[madelin]

If you are billing for an ASC cpt 65779 has a payment indicator N1 (Packaged service/item; no separate payment made.) therefore you will not get additional payment. I would use 65426 too !