65435 CPT Code (2023) | Description, Guidelines, Reimbursement & Example
65435 CPT code bills for service when the physician performs removal of corneal epithelium with or without chemo-cauterization (abrasion, curettage). Physicians perform surgery to remove the outer-most layer of the cornea (the clear tissue that covers the eyeball) by scraping or cutting it with a spatula or curette (e.g., 65435).
Summary
Corneal epithelial defects typically arise from infections, corneal dryness, mechanical trauma, and post-surgical changes. Moreover, The reasons are Ultraviolet burns, Limbal stem cell deficiency, and Neurotrophic keratopathy.
Chemical cauterization may apply to the removal of the cornea. CPT 65436 uses when the physician’s alternative of scrapping and cutting usually requires a swab of EDTA (ethylenediaminetetraacetic acid). This acid destroys the corneal epithelium.
After that, an antibiotic ointment or pressure patch applies to the surgical site once the procedure is complete. A subconjunctival injection or a topical anesthetic may use instead of general anesthesia when the process performs.
Description Of The 65435 CPT Code
65435 CPT code bills for service when the physician performs removal of corneal epithelium with or without chemo-cauterization (abrasion, curettage).
The official description of CPT 65435 is: “Removal of corneal epithelium; with or without chemocauterization (abrasion, curettage).”
Reimbursement
A maximum of 1 unit of 65435 CPT code reimbursement can bill on the same service date. At the same time, two can pay when documentation supports the medical necessity of CPT 65435.
When performed in the facility, the cost and RUVS of CPT 65435 will be $76.12 and 2.19972, respectively. In comparison, non-facility will be $ 92.39 and 2.66972, respectively.
Surgical trays (A4550) does not cover by Medicare, and It’s not appropriate to bill separately. Check the third-party or commercial payers’ guideline if they cover this service.
65435 CPT Code Reimbursement Billing Guidelines
65435 CPT code includes an Operating microscope (69990) and does not report separately.
CPT 64535 performs in combination with Collagen cross-linking. The cornea (0402T) reports CPT 0402T separately with the appropriate modifier.
CPT 65436 reports instead 65436 when removal of cornea tissue performs other than cutting and scrapping.
Billig Example
The following is an example case of when the 65435 CPT code may be used.
A 60-year-old male with no medical history now presents to the hospital outpatient setting for blurry vision and ocular pain. The patient lays in bed at 10 pm and begins having a gradual onset pulsating frontal and occipital headache.
He reports that the pain was very severe. His headaches are usually associated with HTN. The blood pressure shows a value of 210/100. It denies associated dizziness, chest pain, shortness of breath, motor weakness, numbness/tingling, abdominal pain, nausea/vomiting.
The physician ordered an MRI and CT of the eyes and consulted with an ophthalmologist. He suggested Corneal epithelium removal and scheduled an appointment for next week. It helps to clear the visibility of the patient.
CPT code 65435 was billed in this case.
