Performed for the correction of surgically induced astigmatism

Corneal Relaxing Incisions:
Correction of surgically induced astigmatism is covered provided
the patient had previous surgery for penetrating keratoplasty
(65730-65755) within the last 36-60 months or cataract surgery
(66830-66986) within the last 24-36 months.

The degree of astigmatism must be 4.00 diopters or greater.

The patient should be intolerant of glasses or contacts.

CPT Codes
65772    Corneal relaxing incision for correction of surgically induced
              astigmatism
65775    Corneal wedge resection for correction of surgically induced
              astigmatism

Refractive Keratoplasty:
Refractive keratoplasty is surgery to reshape the cornea of the
eye to correct vision problems such as myopia (nearsightedness)
and hyperopia (farsightedness). Refractive keratoplasty procedures include keratomileusis, in which the front of the cornea is removed, frozen, reshaped, and stitched back on the eye to correct either near
or farsightedness; keratophakia, in which a reshaped donor cornea
is inserted in the eye to correct farsightedness; and radial keratotomy,
in which spoke-like slits are cut in the cornea to weaken and flatten
the normally curved center portion to correct nearsightedness.

Per Medicare guidelines, the correction of common refractive errors
by eyeglasses, contact lenses or other prosthetic devices is specifically excluded from coverage. The use of radial keratotomy and/or kera- toplasty for the purpose of refractive error compensation is considered
a substitute or alterative to eye glasses or contact lenses, which are specifically excluded, except in certain cases in connection with cataract surgery. In addition, many in the medical community consider such procedures cosmetic surgery which is also excluded. Therefore, radial keratotomy and keratoplasty to treat refractive defects are not covered (by Medicare).

CPT Codes
65760    Keratomileusis
65765    Keratophakia
65767    Epikeratoplasty
65771    Radial keratotomy

Coding Guidelines
For the purpose of review, it would be appropriate to bill procedure
codes 65772-65775 using the following ICD-9 codes:

996.51    Mechanical complication due to corneal graft
996.53    Mechanical complications due to ocular lens prosthesis
V43.1    Organ/tissue replaced by transplant, lens
V42.5    Organ/tissue replaced by transplant, cornea
V45.6    States following surgery of eyes

The following codes would be inappropriate to use with procedure
codes 65772-65775.

367.20    Astigmatism; unspecified
367.21    Astigmatism; regular
367.22    Astigmatism; irregular