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Need guidance for coding

louise Posted Tue 18th of February, 2020 06:35:14 AM
Medial symblepharon lysis with reconstruction of the upper and lower fornix with mucous membrane graft Lateral symblepharon lysis with reconstruction of the lower fornix with mucous membrane graft Medial canthoplasty 67950 Placement of prokera graft on ocular surface 65779 sutured amniotic membrane graft 65780
SuperCoder Answered Wed 19th of February, 2020 07:26:09 AM

Hi Louise,

CPT 68335 can be used for "repair of symblepharon; with free graft conjunctiva or buccal mucous membrane (includes obtaining graft)". In this procedure, the provider frees or excises (lysis) the scar tissue or adhesions between the palpebral and bulbar conjunctivae and dissects the fibrotic tissue away from the healthy conjunctiva. He then advances and secures it with sutures. The provider uses a free conjunctival graft or buccal mucosa to repair the defect.

CPT 67950 is appropriate for medial or lateral canthoplasty.

On the other hand, when there is suturing of amniotic membrane graft for multiple layers, then use CPT 65780, otherwise if it is single layer suture then use CPT 65779. As per CCI edits, Code 65780 is a column 2 code for 65779, but you may use a CCI-associated modifier to override the edit under appropriate circumstances. But, due to clinical similarities in both the procedures (65779 and 65780), it is suggested not to bill both the codes together. Check your complete documentation and select the appropriate code.

Also, it is suggested to append the side modifier LT and RT, if applicable.

Hope this helps!

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