Coding amniotic membrane graft
Created Oct 2011
Reviewed Dec 2019
What procedure code should be assigned for insertion of amniotic membrane graft?
Patient previously had a corneal graft for keratoconus and now presents with a complication of the corneal graft which required insertion of ProKera™, which is a brand of amniotic membrane graft.
‘ProKera™ is a corneal epithelial device consisting of an ophthalmic conformer that incorporates amniotic membrane (AminoGraft™). ProKera™ is specially preserved in the frozen state and the natural biological/physiological properties of the membrane remain. Therefore, it can promote healing, prevent scarring, minimise pain, diminish the formation of new blood vessels and reduce inflammation on the ocular surface.’ Reference Bio-Tissue website.
The most appropriate procedure code to assign for insertion of amniotic membrane graft (ProKera™) is 90066-00  Other repair of cornea and free text used on the code description, e.g. 90066-00  Insertion ProKera L eye.
If other sources of amniotic membrane graft other than ProKera™ are used, they may be sutured in place – e.g. sutured to the sclera. These would be also be coded 90066-00  Other repair of cornea with free text used on the code description e.g. 90066-00  Amniotic membrane graft L eye.
Note: Following the ACHI Index lead term ‘graft’ would not be appropriate in these cases.