CPT® Code 65420

The procedure described by CPT® Code 65420 involves the excision or transposition of a pterygium without the use of a graft. A pterygium is characterized as a raised, triangular growth of conjunctival tissue that typically appears at the corner of the eye, extending onto the sclera and potentially encroaching upon the cornea. This growth can lead to discomfort, visual disturbances, and cosmetic concerns for the patient. The surgical intervention is necessary when the pterygium extends into the central cornea, necessitating its removal to alleviate symptoms and prevent further complications. During the procedure, the surgeon meticulously dissects the pterygium away from the underlying scleral and corneal tissues, performing a simple excision. Importantly, the scleral surface is left open to heal naturally, which distinguishes this procedure from other methods that involve grafting techniques. In contrast, CPT® Code 65426 refers to a more complex procedure where the pterygium is excised, and the resulting scleral defect is repaired using a graft, either an autograft or an allograft. The distinction between these codes is crucial for accurate medical coding and billing, as it reflects the complexity and resources involved in the surgical approach taken.