Coding for Stripping Keratoplasty Procedures
Keratoplasty is the general term for several variants of corneal transplant. Current Procedural Terminology (CPT) code 65710 covers lamellar keratoplasty, in which only the outermost layers of cornea are transplanted. CPT codes 65730, 65750, and 65755 refer respectively to full-thickness (penetrating) corneal transplant in a phakic patient, an aphakic patient (with no native lens), and a psuedophakic patient (with an artificial lens). The physician work allowance (Relative Value Unit (RVU)) for each of the three penetrating keratoplasty codes is similar.
A newer procedure is termed "Descemet's stripping endothelial keratoplasty" or "deep lamellar endothelial keratoplasty" (also known as DSAEK). This procedure involves a small incision to allow intraocular placement of endothelium harvested from a donor cornea after the stripping off of diseased corneal endothelium. Microkeratome-based (automated) preparation of the donor endothelium may be used. This technique offers certain clinical advantages while achieving the goal of penetrating keratoplasty in patients with disease largely related to endothelial dysfunction.
For Medicare Part B, the new Descemet's stripping procedure may be adequately coded as 65730, 65750, or 65755 (based on the patient's lens status), until such time as a more specific code is released. Coding with an unlisted procedure code such as 66999 is not incorrect, but will trigger delays for additional documentation requests, processing, review, and cross-walking of reimbursement.
Note that keratoplasty procedures primarily for refractive correction and radial keratotomy are NOT covered by Medicare. (CMS Manual System, Pub. 100-03, Medicare National Coverage Determinations Manual, Section 80.7, Refractive Keratoplasty.) The CPT manual (at 65710) gives an instruction to use other codes for refractive keratoplasty such as CPT codes 65760, 65765, and 65767.
References:
- Van Rij G, Bartels M. (2006) Descemet's stripping with endothelial keratoplasty in 50 eyes: a refractive neutral corneal transplant. J Refract Surg. 22:529-30
- Price FW Jr, Price MO (2006) Descemet's stripping with endothelial keratoplasty in 200 eyes. J Cataract Refract Surg. 2006 32:411-8. By the same authors: Descemet's Stripping with Endothelial Keratoplasty :Comparative Outcomes, in Ophthalmology, August 2006.
- Terry MA, Ousley PJ (2005) Deep Lamellar Endothelial Keratoplasty: Visual Acuity, Astigmatism, and Endothelial Survival in a Large Prospective Series. Ophthalmology 112:1541-8
- CMS Manual System, Pub. 100-03, Medicare National Coverage Determinations Manual, Section 80.7, Refractive Keratoplasty
