Refractive KeratoplastyMedical Policy: 09.03.06 This policy applies to all products unless specific contract limitations, exclusions or exceptions apply. Please refer to the member's coverage manual for benefit availability. Managed care guidelines related to referral authorization, and precertification of inpatient hospitalization, home health, home infusion and hospice services apply. Refractive keratoplasty is a generic term that includes all surgical procedures on the cornea to improve vision by changing the refractive index of the corneal surface. Refractive keratoplasties include the following surgeries: Radial Keratotomy (RK) is a surgical correction for myopia (nearsightedness). Using a high-powered microscope, the physician places microincisions (usually eight or fewer) on the surface of the cornea in a pattern much like the spokes of a wheel. The incisions are very precise in terms of depth, length, and arrangement. The microincisions allow the central cornea to flatten, thus reducing the convexity of the cornea, which produces an improvement in vision. Photorefractive Keratectomy (PRK) uses a computerized laser to correct myopia (nearsightedness). The excimer laser is well-suited for cornea reshaping, because the removal of just tiny amounts of tissue can produce the results needed to correct nearsightedness. The excimer laser produces a beam of ultraviolet light in pulses that last only a few billionths of a second. Each pulse removes a microscopic amount of tissue by evaporating it, producing very little heat and usually leaving underlying tissue almost untouched. Overall, the surgery takes approximately 10–20 minutes; however, the use of the laser beam lasts only 15–40 seconds. Automated Lamellar Keratoplasty (ALK) can correct hyperopia. For the treatment of moderate farsightedness, the cornea is opened across the top to form a type of “cap,” using an automated instrument. When the “cap” is positioned back into its original location on top of the eye, microscopic scar tissue is formed, causing the “cap” to bulge out, thus correcting the overly flattened cornea that is associated with hyperopia. Almost like Velcro, the cornea and “cap” adhere to each other, eliminating the need for sutures. Normally, one eye is treated at a time, with about 3 to 4 weeks allowed between each eye surgery. To ease any discomfort, the eye is anesthetized with special drops, and the patient is given a mild sedative to remain relaxed and aware throughout the procedure. Minimally Invasive Radial Keratotomy (mini-RK) is intended in cases of myopia, to alter the cornea’s shape and consequently the refraction by reducing the millimeters of cornea that are incised. Hexagonal Keratotomy is a form of refractive corneal surgery used to treat naturally occurring hyperopia (far-sightedness) and presbyopia (loss of accommodation in the eyes in advancing age) following radial keratotomy. A hexagonal pattern of intersecting incisions in the cornea is used in performing this procedure. All of the above procedures can be used alone or in combination to produce the optimal result for a given patient. Keratomileusis involves removing, freezing, and lathing the patient’s cornea, followed by its replacement onto the corneal bed. This surgery has been proposed for myopia and aphakic hyperopia (aphakia is the absence of the lens of the eye). Keratophakia involves removing the patient’s cornea followed by placement of a lathed donor cornea beneath the recipient’s cornea, which is then reattached. This surgery has been proposed for aphakic hyperopia. Epikeratophakia (lamellar keratoplasty) involves suturing a prelathed donor cornea onto the surface of the recipient’s cornea. This surgery has been proposed as a means of correcting adult and pediatric aphakia, keratoconus (a conical protrusion of the cornea, caused by thinning of the stroma, and resulting in major changes in the refractive power of the eye), and myopia. Radial keratotomy is considered medically necessary in the treatment of myopia that cannot be corrected with lenses (eyeglasses, contacts). Epikeratophakia is considered medically necessary in the treatment of aphakia. All other refractive keratoplasty procedures listed under the Description section of the policy are considered investigational. Also see separate policies regarding Phototherapeutic Keratectomy, policy 09.03.05 and Implantation of Intrastromal Corneal Ring Segments, policy 09.03.09. Procedure Codes and Billing Guidelines:
*Current Procedural Terminology © 2008 American Medical Association. All Rights Reserved. Wellmark medical policies address the complex issue of technology assessment of new and emerging treatments, devices, drugs, etc. They are developed to assist in administering plan benefits and constitute neither offers of coverage nor medical advice. Wellmark medical policies contain only a partial, general description of plan or program benefits and do not constitute a contract. Wellmark does not provide health care services and, therefore, cannot guarantee any results or outcomes. Participating providers are independent contractors in private practice and are neither employees nor agents of Wellmark or its affiliates. Treating providers are solely responsible for medical advice and treatment of members. Our medical policies may be updated and therefore are subject to change without notice. |
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