How To Use CPT Code 65426

CPT 65426 describes the excision or transposition of a pterygium, along with the use of a graft, to improve patient comfort and vision. 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 65426?

CPT 65426 can be used to describe a surgical procedure in which a provider removes or repositions a pterygium, a noncancerous growth that starts in the thin tissue or conjunctiva of the eye. During this procedure, a graft is also performed to repair or replace the affected tissue. The purpose of this procedure is to improve patient comfort and vision.

2. Official Description

The official description of CPT code 65426 is: ‘Excision or transposition of pterygium; with graft.’

3. Procedure

1. When performing CPT 65426, the provider first separates the pterygium from the underlying scar tissue of the sclera.
2. Using a muscle hook, the provider excises the entire pterygium.
3. Bleeding is controlled using electrocautery.
4. The provider carefully dissects the head of the pterygium from the apex toward the limbus.
5. The upper angle of the conjunctiva is grasped with fine forceps, and the conjunctiva is separated from the underlying Tenon’s capsule using Westcott scissors.
6. The provider measures the size of the wound defect and harvests a graft to be placed on the scleral bed.
7. The graft is attached onto the conjunctiva using multiple sutures.
8. The harvest site wound is left open to heal on its own.

4. Qualifying circumstances

CPT 65426 is performed on patients with pterygium, a noncancerous growth in the eye’s conjunctiva. The procedure is done to improve patient comfort and vision. The provider must carefully separate the pterygium from the underlying scar tissue, excise it completely, and perform a graft to repair or replace the affected tissue.

5. When to use CPT code 65426

CPT code 65426 should be used when a provider performs the excision or transposition of a pterygium and also performs a graft to repair or replace the affected tissue. This code is appropriate when the procedure is done to improve patient comfort and vision. It should not be used if the graft is not performed.

6. Documentation requirements

To support a claim for CPT 65426, the provider must document the following information:

• Patient’s diagnosis of pterygium
• Details of the procedure, including the excision or transposition of the pterygium and the use of a graft
• Size of the wound defect
• Method of graft attachment
• Any additional relevant information or complications

7. Billing guidelines

When billing for CPT 65426, ensure that the excision or transposition of the pterygium is performed along with the use of a graft. This code should not be reported if the graft is not performed. It is important to accurately document the details of the procedure and any complications that may arise.

8. Historical information

CPT 65426 was added to the Current Procedural Terminology system on January 1, 1990. There have been no updates to the code since its addition.

9. Examples

1. A provider performs CPT 65426 on a patient with a pterygium, excising the growth and performing a graft to repair the affected tissue.
2. During a surgical procedure, a provider uses CPT 65426 to remove a pterygium and perform a graft to improve the patient’s comfort and vision.
3. A patient undergoes CPT 65426, during which a provider excises a pterygium and performs a graft to repair the affected tissue.
4. Using CPT 65426, a provider performs a surgical procedure to remove a pterygium and repair the affected tissue with a graft.
5. A pterygium is excised and a graft is performed by a provider using CPT 65426 to improve the patient’s comfort and vision.
6. During a surgical procedure, a provider utilizes CPT 65426 to remove a pterygium and perform a graft to repair the affected tissue.
7. A patient undergoes CPT 65426, during which a provider excises a pterygium and performs a graft to repair the affected tissue.
8. Using CPT 65426, a provider performs a surgical procedure to remove a pterygium and repair the affected tissue with a graft.
9. A pterygium is excised and a graft is performed by a provider using CPT 65426 to improve the patient’s comfort and vision.
10. During a surgical procedure, a provider utilizes CPT 65426 to remove a pterygium and perform a graft to repair the affected tissue.