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The procedure described by CPT® Code 65420 involves the excision or transposition of a pterygium without the use of a graft. A pterygium is characterized as a raised, triangular growth of conjunctival tissue that typically appears at the corner of the eye, extending onto the sclera and potentially encroaching upon the cornea. This growth can lead to discomfort, visual disturbances, and cosmetic concerns for the patient. The surgical intervention is necessary when the pterygium extends into the central cornea, necessitating its removal to alleviate symptoms and prevent further complications. During the procedure, the surgeon meticulously dissects the pterygium away from the underlying scleral and corneal tissues, performing a simple excision. Importantly, the scleral surface is left open to heal naturally, which distinguishes this procedure from other methods that involve grafting techniques. In contrast, CPT® Code 65426 refers to a more complex procedure where the pterygium is excised, and the resulting scleral defect is repaired using a graft, either an autograft or an allograft. The distinction between these codes is crucial for accurate medical coding and billing, as it reflects the complexity and resources involved in the surgical approach taken.
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The procedure coded under CPT® Code 65420 is indicated for the removal of a pterygium that has extended into the central cornea, causing potential visual impairment, discomfort, or cosmetic concerns. The following conditions may warrant this surgical intervention:
The procedure for excision or transposition of a pterygium without grafting involves several key steps, which are detailed as follows:
Following the excision of the pterygium, patients can expect a recovery period during which the eye will heal. The scleral surface is left open, and healing occurs naturally over time. Patients are usually advised to avoid rubbing their eyes and to follow any prescribed post-operative care instructions, including the use of medications to manage discomfort and prevent infection. Regular follow-up appointments may be scheduled to monitor the healing process and ensure that there are no complications, such as recurrence of the pterygium or infection.
| Short Descr | REMOVAL OF EYE LESION | Medium Descr | EXCISION/TRANSPOSITION PTERYGIUM W/O GRAFT | Long Descr | Excision or transposition of pterygium; without graft | Status Code | Active Code | Global Days | 090 - Major Surgery | PC/TC Indicator (26, TC) | 0 - Physician Service Code | Multiple Procedures (51) | 2 - Standard payment adjustment rules for multiple procedures apply. | Bilateral Surgery (50) | 1 - 150% payment adjustment for bilateral procedures applies. | Physician Supervisions | 09 - Concept does not apply. | Assistant Surgeon (80, 82) | 1 - Statutory 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 | Surgical procedure on ASC list in CY 2007; payment based on OPPS relative payment weight. | Type of Service (TOS) | 2 - Surgery | Berenson-Eggers TOS (BETOS) | P4E - Eye procedure - other | MUE | 1 | CCS Clinical Classification | 19 - Other therapeutic procedures on eyelids, conjunctiva, cornea |
| RT | Right side (used to identify procedures performed on the right side of the body) | 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.) | LT | Left side (used to identify procedures performed on the left side of the body) | 50 | Bilateral procedure: unless otherwise identified in the listings, bilateral procedures that are performed at the same session, should be identified by adding modifier 50 to the appropriate 5 digit code. note: this modifier should not be appended to designated "add-on" codes (see appendix d). | 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). | 54 | Surgical care only: when 1 physician or other qualified health care professional performs a surgical procedure and another provides preoperative and/or postoperative management, surgical services may be identified by adding modifier 54 to the usual procedure number. | 55 | Postoperative management only: when 1 physician or other qualified health care professional performed the postoperative management and another performed the surgical procedure, the postoperative component may be identified by adding modifier 55 to the usual procedure number. | 59 | Distinct procedural service: under certain circumstances, it may be necessary to indicate that a procedure or service was distinct or independent from other non-e/m services performed on the same day. modifier 59 is used to identify procedures/services, other than e/m services, that are not normally reported together, but are appropriate under the circumstances. documentation must support a different session, different procedure or surgery, different site or organ system, separate incision/excision, separate lesion, or separate injury (or area of injury in extensive injuries) not ordinarily encountered or performed on the same day by the same individual. however, when another already established modifier is appropriate it should be used rather than modifier 59. only if no more descriptive modifier is available, and the use of modifier 59 best explains the circumstances, should modifier 59 be used. note: modifier 59 should not be appended to an e/m service. to report a separate and distinct e/m service with a non-e/m service performed on the same date, see modifier 25. | AQ | Physician providing a service in an unlisted health professional shortage area (hpsa) | E1 | Upper left, eyelid | E2 | Lower left, eyelid | E4 | Lower right, eyelid | GC | This service has been performed in part by a resident under the direction of a teaching physician | GW | Service not related to the hospice patient's terminal condition | Q6 | Service furnished under a fee-for-time compensation arrangement by a substitute physician or by a substitute physical therapist furnishing outpatient physical therapy services in a health professional shortage area, a medically underserved area, or a rural area | SG | Ambulatory surgical center (asc) facility service | XS | Separate structure, a service that is distinct because it was performed on a separate organ/structure | XU | Unusual non-overlapping service, the use of a service that is distinct because it does not overlap usual components of the main service |
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| Pre-1990 | Added | Code added. |
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