Marina Posted Mon 06th of January, 2020 13:07:13 PM
Can codes 65780 and 65426 be billed together to Medicare? If so, what is the correct way to bill?
SuperCoder Answered Tue 07th of January, 2020 07:27:27 AM
Thank you for your question.
CPT code 65780, (Ocular surface reconstruction; amniotic membrane transplantation, multiple layers) was designed for use in severe ocular surface disease in which there is a persistent corneal epithelial defect as well as stromal thinning due to neurotrophic keratopathy, corneal ulcer, or non-healing surgical wounds.
This procedure involves debridement of the involved epithelium and stroma followed by the placement and suturing of one or more layers of amniotic membrane over the defect.
There is another surgical service that utilizes amniotic membrane that may lead to some confusion in coding. In some surgical procedures, amniotic membrane is used after the removal of a conjuctival growth known as pterygium. In those situations, the correct code to report is 65426, Excision or transposition of pterygium; with graft.
CCI has bundled code 65780 into 65426 (Excision or transposition of pterygium; graft). So, we cannot bill both codes together if performed on same eye in same session.
we can report the two codes separately under certain circumstances -- for example, if the ophthalmologist performs the procedures on different eyes.
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.
The facility should report HCPCS code V2790 (Amniotic membrane for surgical reconstruction, per procedure) for the supply of the donor tissue.
Feel free to ask for any further query.