In recent months, the Academy has received several questions asking about the appropriate coding for CPT code 65780 Amniotic membrane transplantation (AMT). Here is one example:
Question. “Could you please interpret CPT code 65780 ocular surface reconstruction; AMT. The physician in my practice uses this code whenever he uses a ProKera amniotic membrane. For instance, the patient has an alkaline chemical burn of the cornea, we document ICD-9 code 940.2 (alkaline chemical burn of cornea and conjunctival sac), and the physician places a ProKera membrane but doesn’t suture it. Instead he performs temporary closure of the eyelids by suture and codes CPT code 65780, but this would seem to fall under CPT code 67875.”
Answer. For CPT code 65780, Medicare assigns a total of 20.91 relative value units. This total includes 10.43 work RVUs, 10.04 practice expense RVUs and 0.44 malpractice expense RVUs. (For an explanation of the Resource-Based Relative Value Scale that assigns RVU values to CPT codes, see the June Practice Perfect article at www.eyenetmagazine.org/archives.)
The 10.43 work RVUs are for the work involved in reconstructing the ocular surface, including suturing of the amniotic membrane graft to the cornea to anchor it in position. Placing a ProKera ring involves no dissection of the ocular surface to remove scar tissue, and no suturing or gluing of the tissue. Physician work is similar to that for placement of a therapeutic contact lens (CPT code 92070, fitting of contact lens for treatment of disease, including supply of lens). However, 92070 is not an appropriate code because the reimbursement does not take into account the cost of the ProKera ring.
Temporary closure of the eyelid, CPT code 67875, is assigned a total of 4.51 RVUs in office and 2.34 RVUs in a facility because it is far less difficult and takes less time than 65780.
For the case in question, you should use CPT code 67875, temporary closure of eyelids by suture. There is no separate code or physician payment for placement of the ProKera ring. If done as part of an office visit, it is included as part of the E&M or eye code. However, you should also submit code V2790, amniotic membrane for surgical reconstruction, to get reimbursed for supply of the ProKera tissue ring.
Please note: Inappropriate use of 65780, ocular surface reconstruction; AMT, for placing ProKera or for AMT as an add-on to pterygium surgery, another potential area for abuse, might result in reevaluation of the code. The danger of such a reassessment is that the code could be reduced to a value that is commensurate with fitting of a bandage contact lens.
—David B. Glasser, MD, member of the Academy Health Policy Committee