NOV 14, 2023
Upper and Lower Canaliculi Laceration Repair
The surgeon operated on a child with laceration of both the upper and lower canaliculi of the same eye. There is an ICD-10 code for right and left lids but not right upper, right lower, left upper and left lower. How can we indicate two separate procedures were performed, repairing lacerated right upper and right lower canaliculi, if there is no distinction for upper and lower lids? Should we append modifier -50 and link the right lid diagnosis code?
Answer:
CPT code 68700 has a Medically Unlikely Edit (MUE) of 1 per National Correct Coding Initiative edits, payment is per eye. In this tragic case, appending modifier -50 would incorrectly indicate that both eyes were operated on. Submit only CPT code 68700 with the appropriate diagnosis code linked.