How To Use CPT Code 65420

CPT 65420 describes the excision or transposition of a pterygium without a graft. This article will cover the description, procedure, qualifying circumstances, appropriate usage, documentation requirements, billing guidelines, historical information and billing examples.

1. What is CPT Code 65420?

CPT 65420 can be used to describe the surgical procedure in which a healthcare provider removes or repositions a pterygium, a non-cancerous growth that starts in the conjunctiva of the eye. This procedure aims to improve patient comfort and vision by eliminating the pterygium. Unlike CPT 65426, which involves the use of a graft, CPT 65420 does not require the placement of any additional material.

2. Official Description

The official description of CPT code 65420 is: ‘Excision or transposition of pterygium; without graft.’

3. Procedure

1. During the procedure, the healthcare provider prepares the patient and administers anesthesia.
2. The provider then separates the pterygium from the underlying scar tissue of the sclera, which is the thick fibrous outer covering of the eyeball.
3. Using a muscle hook, the provider excises the entire pterygium through the upper conjunctiva.
4. To control bleeding, the provider employs electrocautery, a technique that uses an electrically heated instrument to stop bleeding.
5. The provider leaves the sclera open to heal on its own, without the need for a graft.

4. Qualifying circumstances

CPT 65420 is performed on patients with pterygium, a non-cancerous growth in the conjunctiva of the eye. The procedure is suitable for patients who experience discomfort or vision problems due to the pterygium. It is important to note that CPT 65420 does not involve the use of a graft, unlike CPT 65426.

5. When to use CPT code 65420

CPT code 65420 should be used when a healthcare provider performs the excision or transposition of a pterygium without a graft. This code is appropriate when the provider removes or repositions the pterygium to improve patient comfort and vision. If a graft is used during the procedure, CPT code 65426 should be reported instead.

6. Documentation requirements

To support a claim for CPT 65420, the healthcare provider must document the following information:

• Patient’s diagnosis of pterygium and the need for the excision or transposition procedure
• Details of the procedure performed, including the specific techniques used
• Date of the procedure
• Any additional information relevant to the patient’s condition or the procedure
• Signature of the healthcare provider performing the procedure

7. Billing guidelines

When billing for CPT 65420, ensure that the procedure performed does not involve the use of a graft. If a graft is used, CPT code 65426 should be reported instead. It is important to follow the specific guidelines provided by the payer regarding the use of CPT 65420 and any associated modifiers or documentation requirements.

8. Historical information

CPT 65420 was added to the Current Procedural Terminology system on January 1, 1990. There have been no updates or changes to the code since its addition.

9. Examples

1. A healthcare provider performs the excision of a pterygium without a graft to improve a patient’s vision.
2. During the procedure, the provider transposes a pterygium to a different location on the conjunctiva without using a graft.
3. A patient undergoes the excision of a pterygium without a graft to alleviate discomfort and improve their quality of life.
4. A healthcare provider removes a pterygium without a graft to prevent further vision deterioration in a patient.
5. During the procedure, the provider repositions a pterygium without using a graft to enhance the patient’s visual acuity.
6. A patient with a pterygium undergoes the excision procedure without a graft to address cosmetic concerns.
7. The healthcare provider performs the transposition of a pterygium without a graft to improve the patient’s ocular health.
8. A pterygium is excised without a graft to alleviate symptoms and prevent further growth in a patient.
9. The healthcare provider removes a pterygium without a graft to restore the patient’s visual function.
10. A patient undergoes the transposition of a pterygium without a graft to correct astigmatism caused by the growth.