Wednesday, August 11, 2010

CPT code 65730 and 65759, 65710, 65750





Descement’s Stripping Lamellar Endothelial Keratoplasty (DSLEK)

DSLEK is a new procedure for corneal transplantation where only the diseased endothelium is replaced, opposed to the standard Penetrating Keratoplasty (PKP) where the full endothelium is replaced. The use of DSLEK/DSAEK results in significantly shorter healing time and is covered by Medicare.

Billing Guidelines for Dates of Service January 1, 2008 – December 31, 2008

Medicare will reimburse physicians for the DSLEK procedure. This procedure should be billed by the physician to Medicare with CPT code 66999. The description of this procedure must be included in Item 19 of the CMS-1500 claim form or the electronic equivalent.

This procedure is considered for payment when performed in an ASC setting; however, CPT code 66999 is not on the CMS list of approved ASC facility codes for 2008. Therefore, the physician’s reimbursement will be such that the amount payable to the ASC will be included. For this procedure, the physician would enter into a financial agreement with the ASC for a portion of the Medicare reimbursement.

It will be at the discretion of the ASC facility to establish the financial agreement and payment arrangements with the physician. Medicare would not be involved in the arrangement.

Note: Procedure code 65730 should not be used to bill for DSLEK/DSAEK

Billing guidelines for dates of service on or after January 1, 2009:

The American Medical Association (AMA) has added a new CPT code that now describes DSLEK. This code should now be utilized instead of the Not Otherwise Classified (NOC) code 66999 used in 2008.

The ASC as well as the physician should use the new code for DSLEK services rendered on or after January 1, 2009.

Added Keratoprosthesis (65770, C1818) requires prior authorization for HMO, Individual Marketplace, Elite, Advantage per TAWG decision. Changed name of policy from Corneal Transplant to Corneal Transplant and Keratoprosthesis. Policy reviewed and updated to reflect most current clinical evidence. Approved by Medical Policy Steering Committee as revised.

65756© Corneal trnspl, endothelial

The ASC can now bill this service independently and not have to establish a financial agreement and payment arrangements with the physician

Keratoplasty Procedure codes

• 65710 – Anterior lamellar, only a portion of the cornea is removed (anterior stroma & Bowman’s membrane)

• 65730 – Penetrating (except in aphakia or pseudophakia) – patient has their natural lens in place

• 65750 - Penetrating (in aphakia) – patient’s natural lens is absent (previously removed)

• 65755 – Penetrating (in pseudophakia) – false lens (usually an IOL has been previously placed) Lens status is determined by how the patient presents for surgery

QUESTION: Are there any other restrictions on Medicare reimbursement?

ANSWER: Yes. Medicare’s National Correct Coding Initiative (NCCI) edits bundle amniotic membrane tissue transplantation procedures (65779, 65780) with pterygium removal (65420, 65426), and with the keratoplasty codes (65710, 65730, 65750, 65755, 65756). NCCI edits change quarterly; you should check them periodically.

Corneal Transplants

• Codes 65730, 65750, 65755 - Keratoplasty

– Status of patient’s lens determines proper code

• Natural - Code 65730

• Aphakic - Code 65750

• Pseudophakic - Code 65755

– If performed with cataract surgery, it becomes the primary procedure

Billing Instructions for Corneal Tissue

As finalized in the CY 2016 OPPS/ASC final rule with comment period (80 FR 70472), procurement/acquisition of corneal tissue will be paid separately only when it is used in corneal transplant procedures. Specifi cally, corneal tissue will be separately paid when used in procedures performed in the OPD only when the corneal tissue is used in a corneal transplant procedure described by one of the following CPT codes:

• 65710 (Keratoplasty (corneal transplant); anterior lamellar);

• 65730 (Keratoplasty (corneal transplant); penetrating (except in aphakia or pseudophakia));

• 65750 (Keratoplasty (corneal transplant); penetrating (in aphakia));

• 65755 (Keratoplasty (corneal transplant); penetrating (in pseudophakia));

• 65756 (Keratoplasty (corneal transplant); endothelial and any successor code or new code describing a new type of corneal transplant procedure that uses eye banked corneal tissue.

HCPCS code V2785 (Processing, preserving, and transporting corneal tissue) should only be reported when corneal tissue is used in a corneal transplant procedure; V2785 should not be reported in any other circumstances.


CMS policy recognizes two tracking codes for preparing grafts with femtosecond lasers. A tracking code allows CMS to collect data about cost and usage of new procedures. CMS does not assign payment to tracking codes, so reimbursement is at the discretion of the insurance carrier.

You should not expect to this service to reimbursed by Medicare carriers, so you may want to have a Medicare beneficiary who opts for FLAK surgery to sign an Advance Beneficiary Notice that payment for the service would be denied (if you do that, note the modifier GA on your claim).

+0289T indicates femtosecond laser preparation of the donor graft. This code should be reported when the physician prepares tissue, not when an eye bank cuts with a femtosecond laser

+0290T is used for a femtosecond laser incision in the recipient’s cornea.

These tracking codes modify the anterior lamellar (ALK) and penetrating keratoplasty (PK) CPT codes in the table above (65710, 65730, 65750, and 65755). Femtosecond endothelial graft preparation can be reported when the physician prepares the graft and 65757 (backbench preparation of graft tissue) is included on claim.

0289T, 0290T Shape Your Options for Intralase-Assisted Keratoplasty

Use two new temp codes to represent the emerging laser corneal incision technology.

If your ophthalmic surgeon is one of the trailblazers putting aside his trephine in favor of an advanced laser to perform corneal incisions and transplants, take heart. CPT® 2012 features two temporary codes that describe this emerging technology.

CPT® Category III codes 0289T (Corneal incisions in the donor cornea created using a laser, in preparation for penetrating or lamellar keratoplasty [List separately in addition to code for primary procedure]) and 0290T (Corneal incision in the recipient corneal created using a laser, in preparation for penetrating or lamellar keratoplasty [List separately in addition to code for primary procedure]) will debut in your 2012 CPT® manuals, effective January 1, 2012.

These codes cover the incisions made by a laser, such as the IntraLase FS Laser, into the donor cornea and the recipient site, during a keratoplasty (corneal transplant). By creating custom, unique, matching edges in the donor cornea and recipient site, Intra-Lase Enabled Keratoplasty (IEK) may provide a higher accuracy of fitting and a stronger graft, reducing healing time and improving visual recovery.

You would report 0289T and 0290T in conjunction with the code for the primary corneal procedure:

65710 (Keratoplasty [corneal transplant]; anterior lamellar)
65730 (… penetrating [except in aphakia or pseudophakia])
65750 (… penetrating [in aphakia])
65755 (… penetrating [in pseudoaphakia])

Medicare has not yet assigned relative value units (RVUs) to 0289T and 0290T, so it is unclear how much insurers will reimburse for these codes. CPT® creates Category III codes for emerging technology, services, or procedures that might not be widely performed.

CPT® requires you to bill with the codes in order to track their usage and effectiveness. If a technology (and therefore a code) becomes more widely used, it has the potential to become a Category I. “Codes in this section of the CPT® may or may not eventually receive a Category I CPT® code,” says Lisa Center, CPC, a billing professional with Mt. Carmel Regional Medical Center in Pittsburg, Kan. Category III codes are temporary codes. “They are archived five years from the date of their publication or revision in the CPT® code book, unless it is demonstrated that a temporary code is still needed,” Center says.

No comments:

Post a Comment

Popular Posts