CODING & REIMBURSEMENT

Conjunctivochalasis coding primer

By Suzanne Corcoran

With baby boomers entering their senior years, it’s likely you will be seeing more of conjunctivochalasis. Let’s review the most common, and pressing, coding issues relating to the condition.

Q. What is conjunctivochalasis?

A. The term describes excess folds in the conjunctiva. Symptoms include: foreign-body sensation, redness, irritation, pain and epiphora. Conjunctivochalasis may be associated with aqueous tear deficiency, meibomian gland dysfunction, blepharitis and other less common conditions. It is more common in the elderly due to gradual thinning of the conjunctiva and loss of adhesion to the underlying sclera related to the dissolution of Tenon’s capsule.

Q. What treatments are available for this condition?

A. Treatment with topical anti-inflammatory agents and artificial tears is the first line. Surgery to remove the symptomatic conjunctival folds may be considered when pharmaceuticals provide little or no help.

Q. What documentation supports treatment?

A. A treatment plan is justified by medical necessity and the patient’s pertinent complaint(s). In this case, it would be based on the physician’s examination of the anterior segment and discussion about the treatment options.

Q. What CPT code is used to describe this procedure?

A. Because several surgical techniques involve removal of conjunctival folds, multiple CPT codes may apply. You may use a code describing removal of conjunctival lesion:

68110 – Excision of lesion, conjunctiva; up to 1 cm.

68115 – Excision of lesion, conjunctiva; over 1 cm.

The removal of conjunctival folds may result in a large elliptical defect in the conjunctiva, which the surgeon often repairs with one or two layers of amniotic membrane tissue (AMT) covered with conjunctiva, then sutures in place. AMT provides a scaffold for cell regrowth into the defect and promotes patient recovery. Sometimes the clinician uses tissue glue, with or without AMT.

When the clinician uses AMT, two key factors determine the answer: the number of amniotic membrane layers, and the method of securing the tissue. Applicable codes are:

65779 – Placement of amniotic membrane on the ocular surface for wound healing; single layer, sutured.

65780 – Ocular surface reconstruction; amniotic membrane transplantation, multiple layers.

For placement of amniotic membrane using tissue glue, use 66999.

Q. How frequently are the procedures performed?

A. Not frequently. In 2012, the most recent year for which data is available, Medicare paid CPT 68110 and 68115 about 4,000 and 2,500 times, respectively. CPT 65779 and 65780 were performed about 900 and 2,400 times, respectively. Because 66999 is nonspecific, Medicare has no utilization data.

Q. How is the supply of amniotic membrane reimbursed?

A. For Medicare, it is included in the facility fee when performed in an ASC or hospital. Surgeons rarely perform it in-office; it would be included in the surgeon’s professional fee. HCPCS code V2790, Amniotic membrane for surgical reconstruction per procedure, is no longer eligible for discrete Medicare payment in any setting. Other payers do not necessarily follow Medicare’s approach, so check your payer contracts.