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Collagen cross-linking of the cornea is a specialized ophthalmic procedure aimed at enhancing the structural integrity of the cornea by strengthening the collagen fibers within it. This is achieved through the application of riboflavin, also known as Vitamin B2, in conjunction with ultraviolet-A (UV-A) light. The procedure is particularly beneficial for patients suffering from conditions such as keratoconus, pellucid marginal degeneration, and ectasia that may arise following LASIK surgery. By increasing the number of fiber anchors that bond collagen together, collagen cross-linking serves as a first-line treatment option to stabilize the cornea and prevent further progression of these conditions. Additionally, this technique may be employed to address corneal ulcers and infections, as well as to secure Intacs, which are small plastic discs implanted within the cornea to improve its shape. During the procedure, the patient is positioned reclining, and a lid speculum is utilized to keep the eyelids open. Anesthetic eye drops are administered to ensure patient comfort. The procedure may involve the removal of a thin layer of corneal epithelium to facilitate quicker absorption of riboflavin, although it can also be performed as a transepithelial procedure with the epithelium intact. The riboflavin solution is applied at specific intervals until it is detected in the anterior chamber of the eye, confirmed by a blue filter on a slit lamp. Following this, UV-A light is directed at the corneal apex for a predetermined duration to initiate the cross-linking process. Post-treatment, ultrasound pachymetry may be conducted to assess the corneal thickness, and antibiotic eye drops are applied, followed by the placement of a bandage contact lens to aid in recovery.
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The procedure of collagen cross-linking of the cornea is indicated for several specific conditions and symptoms, which include:
The procedure of collagen cross-linking involves several critical steps that ensure its effectiveness and safety. Each step is designed to prepare the cornea for the treatment and to facilitate the cross-linking process.
After the collagen cross-linking procedure, patients are typically monitored for any immediate complications. The application of antibiotic eye drops helps to reduce the risk of infection, while the bandage contact lens provides protection and comfort as the cornea heals. Patients may experience some discomfort, light sensitivity, or blurred vision in the days following the procedure, which is generally expected. Follow-up appointments are essential to assess the healing process and to ensure that the cornea is recovering properly. The overall recovery time can vary, but many patients notice improvements in their vision as the cornea stabilizes and heals over the following weeks.
| Short Descr | COLGN CRS-LINK CRN&PACHYMTRY | Medium Descr | COLLAGEN CROSS-LINKING CORNEA&PACHYMTRY | Long Descr | Collagen cross-linking of cornea, including removal of the corneal epithelium, when performed, and intraoperative pachymetry, when performed | Status Code | Carriers Price the Code | Global Days | XXX - Global Concept Does Not Apply | PC/TC Indicator (26, TC) | 0 - Physician Service Code | Multiple Procedures (51) | 0 - No payment adjustment rules for multiple procedures apply. | Bilateral Surgery (50) | 0 - 150% payment adjustment for bilateral procedures does NOT apply. | Physician Supervisions | 09 - Concept does not apply. | Assistant Surgeon (80, 82) | 0 - Payment restriction for assistants at surgery applies to this procedure... | Co-Surgeons (62) | 0 - Co-surgeons not permitted for this procedure. | Team Surgery (66) | 0 - Team surgeons not permitted for this procedure. | Diagnostic Imaging Family | 99 - Concept Does Not Apply | APC Status Indicator | Hospital Part B services paid through a comprehensive APC | ASC Payment Indicator | Office-based surgical procedure added to ASC list in CY 2008 or later without MPFS nonfacility PE RVUs; payment based on OPPS relative payment weight. | Berenson-Eggers TOS (BETOS) | P4E - Eye procedure - other | MUE | 2 |
| 51 | Multiple procedures: when multiple procedures, other than e/m services, physical medicine and rehabilitation services or provision of supplies (eg, vaccines), are performed at the same session by the same individual, the primary procedure or service may be reported as listed. the additional procedure(s) or service(s) may be identified by appending modifier 51 to the additional procedure or service code(s). note: this modifier should not be appended to designated "add-on" codes (see appendix d). | 79 | Unrelated procedure or service by the same physician or other qualified health care professional during the postoperative period: the individual may need to indicate that the performance of a procedure or service during the postoperative period was unrelated to the original procedure. this circumstance may be reported by using modifier 79. (for repeat procedures on the same day, see modifier 76.) | CR | Catastrophe/disaster related | GA | Waiver of liability statement issued as required by payer policy, individual case | GC | This service has been performed in part by a resident under the direction of a teaching physician | GX | Notice of liability issued, voluntary under payer policy | LT | Left side (used to identify procedures performed on the left side of the body) | RT | Right side (used to identify procedures performed on the right side of the body) | XS | Separate structure, a service that is distinct because it was performed on a separate organ/structure |
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| 2023-01-01 | Changed | First appearance of change(s) in codebook. |
| 2022-07-01 | Changed | Code description changed |
| 2022-07-01 | Note | Guideline Added |
| 2020-01-01 | Changed | First appearance of change in code book. |
| 2019-07-01 | Changed | Code description changed. |
| 2019-01-01 | Changed | Code description changed. |
| 2016-01-01 | Added | Added |
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