EyeNet Magazine

Coding & Reimbursement

Put a Lid on Your Coding Problems:
Blepharoplasty at a Glance

By Sue Vicchrilli, COT, OCS, Academy Coding Program Manager

The American Academy of Ophthalmic Executives’ new book Ophthalmic Coding Coach provides comprehensive detail on 380 CPT codes. This month, EyeNet highlights the Coding Coach’s tips for codes 15822 and 15823. When coding for plastic surgery of the eyelids, note the following:

 Preop documentation requirements and the definition of functional vs. cosmetic blepharoplasties is carrier specific, by state. Check the local medical review policy (LMRP).

 For functional blepharoplasties, most LMRPs require documentation of:

  • visual impairment with near or far vision due to dermatochalasis, blepharochalasis and blepharoptosis
  • symptomatic redundant skin weighing down on upper lashes
  • chronic symptomatic dermatitis of pretarsal skin caused by redundant upper-lid skin
  • prosthesis difficulties in an anophthalmic socket

 Performance of external photographs with interpretation and report (CPT code 92285) should be taken to demonstrate one or more of the following:

  • The upper eyelid margin approaches to within 2.5 millimeters (of the diameter of the visible iris) of the corneal light reflex.
  • The upper eyelid skin rests on the eyelashes.
  • The upper eyelid indicates the presence of dermatitis.
  • The upper eyelid position contributes to difficulty tolerating a prosthesis in an anophthalmic socket.

 Performance of visual fields (CPT codes 92081 to 92083) with interpretation and report should be performed once with the eyelids taped up and once with the lids at normal position. The visual field should demonstrate a minimum 12-degree or 30-percent loss of upper field of vision with upper lid skin and/or upper lid margin.

Modifiers. There is one CPT modifier, –50 bilateral procedure, and six HCPC modifiers: –GA Advance Beneficiary Notice is on file; –GY Medicare should deny the claim, the submission of a cosmetic claim is due to patient request; –E1 Upper left, eyelid; E3 Upper right, eyelid; –RT Right eye; and –LT Left eye.

Diagnosis Codes. Appropriate codes are: 373.4 Infective dermatitis of eyelid of types resulting in deformity; 373.5 Other infective dermatitis of eyelid; 373.6 Parasitic infestation of eyelid; 374.00 Entropion, unspecified; 374.01 Senile entropion; 374.02 Mechanical entropion; 374.03 Spastic entropion; 374.04 Cicatricial entropion; 374.05 Trichiasis without entropion; 374.10 Ectropion, unspecified; 374.11 Senile ectropion; 374.12 Mechanical ectropion; 374.13 Spastic ectropion; 374.14 Cicatricial ectropion; 374.30 Ptosis of eyelid, unspecified; 374.31 Paralytic ptosis; 374.32 Myogenic ptosis; 374.33 Mechanical ptosis; 374.34 Blepharochalasis; 374.51 Xanthelasma; 374.87 Dermatochalasis; 375.15 Tear film insufficiency, unspecified; 743.61 Congenital ptosis; 743.62 Congenital deformities of eyelids; and V52.2 Artificial eye.

CCI edits. For 15822: 01995, 11100, 15820, 36000, 36410, 37202, 62318, 62319, 64415–64417, 64450, 64470, 64475, 69990, 90780, 92081–92083 and 92285.

For 15823: 01995, 11100, 15822, 36000, 36410, 37202, 62318, 62319, 64415–64417, 64450, 64470, 64475, 69990, 90780, 92081–92083 and 92285.

RVUs. For 15822: 10.51 (office) and 9.07 (facility); for 15823: 15.22 and 13.67.

Postop. For both 15822 and 15823: 90 days for Medicare and private payer.

Assistant at surgery. N/A.

Plastic Surgery of the Eyelids

15822Blepharoplasty, upper eyelid
15823with excessive skin weighing down lid

To order Ophthalmic Coding Coach (Product #012154), visit www.aao.org/store.


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