The Medicare Code Editor (MCE) detects and reports errors in the coding of claims data. The coding is CPT code 65778 (+ modifier) with the correct diagnosis code. Figure 3. Answer: This procedure is typically paid per eye, not per pterygium. In this noncomparative retrospective study, the medical records of all patients who had pterygium excision with adjunctive amniotic membrane transplantation (AMT) and MMC by the same surgeon (R.R.) The pterygium has been excised and the autograft prepared and reflected onto the cornea at the superior limbus . Prabhasawat P, Ekpo P, Uiprasertkul M, et al. 65426 Excision or transposition of pterygium; with graft $676.09 $490.13 $805.14 $1,812.68 Supply/HCPCS Level II Supply Code 3 Code Description V2790 Amniotic membrane for surgical reconstruction, per procedure March 13, 2019 1 Listed codes are a representative of covered diagnoses but differences in payment policies exist for many payers. The older, standard surgical technique left a bare hole in the conjunctiva (the surface of the eye) where the pterygium was removed. This list is neither exhaustive According to Dr. Gregory, although AM is commonly used for pterygium surgery, he does not use it in primary cases of pterygium excision. Figure 2. Amniotic membrane transplantation after extensive removal of primary and recurrent pterygia. Ophthalmology. 65420 Excision/transposition, pterygium; w/o graft 65426 Excision/transposition, pterygium; w/ graft ... amniotic membrane 65781 Ocular surface reconstruction; limbal stem cell allograft ... 67835 Correction, trichiasis; incision of lid margin, w/ free mucous membrane graft 67840 Excision, lesion, eyelid (except chalazion) Comparison of conjunctival autografts, amniotic membrane grafts, and primary closure for pterygium excision. Br J of Ophthalmol. The trade-off is that the recurrence rate is higher when AM is used. Amniotic membrane graft for primary pterygium: comparison with conjunctival autograft and topical mitomycin C treatment. A third code, 65426 (Excision or transposition of pterygium; with graft), may also apply to surgery using AmnioGraft, but the tissue graft is not separately identified or billed since it is the graft. Note: The code for pterygium doesn’t change if tissue glue is used since 65426 doesn’t specify how … However, since there are two separate incisions/procedures per eye, you may try billing the second procedure with modifier -XS Separate structure to Medicare Part B. Pterygium removal surgery eliminates the abnormal tissue from the cornea and sclera (white of the eye). Ophthalmology. Efficacy of cultivated corneal epithelial stem cells for … 2000;84:973-978. from October 2010 to June 2016, at the Southern California Kaiser Permanente Medical Center, Panorama City, were reviewed. Pterygium Removal Surgery: What to Expect. a Vast pterygium excision a Stevens-Johnson Syndrome amniotic membrane grafts Solutions to support ophthalmic surgical recovery Ambio products are dehydrated human amniotic membrane grafts used to safely and effectively support post-surgical recovery after ophthalmic procedures. The amniotic membrane is placed in the subconjunctival space surrounding the site of pterygium excision. Prabhasawat P, Barton K, Burkett G, et al. (Note: No additional codes are necessary when billing this surgical procedure because reimbursement for the cost of the amniotic membrane and the related office visit is … Question: When the patient has a double pterygium, is it appropriate to submit CPT code 65426 Excision of pterygium; with graft with 2 units and LT modifier to Medicare Part B? The benefit of amniotic membrane in these patients is that it is a shorter procedure and is less technically demanding for the surgeon. The following ICD-10 Code Edits are applicable to this code: ... History of excision of pterygium with amniotic membrane graft; ... History of excision of pterygium with graft to conjunctiva; Figure 4. AmnioGraft is a biologic ocular transplantation graft used by eye surgeons around the world as an adjunct therapy to treat ocular surface indications such as corneal ulcers, pterygium, mechanical dry eye (also known as conjunctivochalasis), excision of tumors, chemical burns, and … 2001;108:449-460. ↑ Ma DH-K, See L-C, Liau S-B, Tsai RJF. 1997;104(6):974-985. Unfortunately, this led to a high rate of pterygium regrowth. Freeze-dried human amniotic membrane is cut into a C-shaped graft .
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