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Ophthalmology Coding Alert

Reader Question: Track Down Scleral Patch Graft Code


- Published on Tue, Oct 14, 2003
Question: Which CPT code should we use for a scleral patch graft following aqueous shunt placement?

Illinois Subscriber
 
Answer:
Use 67255 (Scleral reinforcement [separate procedure]; with graft) for the graft. The reason for the reinforcement is usually a sclera that is thin or weakened, sometimes from previous surgery. The ophthalmologist performs this when inserting the shunt (66180, Aqueous shunt to extraocular reservoir [e.g., Molteno, Schocket, Denver-Krupin]). If the graft is done on the same day as the shunt, file 67255 with modifier -51 (Multiple procedures) appended. These codes are not bundled in the National Correct Coding Initiative.
 
It's not medically necessary to perform 67255 on every patient who gets a shunt. Documentation should include information about the scleral thinning or another reason for the reinforcement procedure.
 
Use 379.19 (Other disorders of sclera; other), an open-ended code. Do not use the staphyloma code (66225, Repair of scleral staphyloma; with graft), which is for an infectious process.
 
- Answers contributed by Raequell Duran, president of Practice Solutions, Santa Barbara, Calif.; Dennis Sandoval, MD, Eye and Facial Surgery of New Mexico, Albuquerque; and John Bell, CEO, Maine Eye Care, Waterville.

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