Blepharoplasty

[Regina Tinney]

New to Plastic Surgery, can anyone tell me the difference between 15823 and 67904.

[FTessaBartels]

Here are the lay descriptions

15823 - The physician performs a blepharoplasty of the upper eyelid. Through an incision usually in the crease of the upper eyelid, the physician dissects the skin of the upper eyelid to the subcutaneous/muscle fascial layers. The skin is pulled tight and redundant skin is excised. Muscle fascia may be sutured to support sagging muscles. In 15823, orbital fat may be removed from the tissues as well as excessive redundant skin that mechanically weighs down the eyelid, obstructing the visual field. The incision is closed with layers.

66904 - Blepharoptosis is a droop or displacement of the upper eyelid resulting from paralysis. The physician administers local anesthetic and the patient's face and eyelid are draped and prepped for surgery. An incision line is outlined along the crease of the upper eyelid. A dissection is carried down the normal insertion point of the distal point of the levator tendon. The levator tendon is isolated. The physician uses sutures to advance the levator tendon onto the tarsal plate in an adjustable fashion. If the patient is old enough to undergo the procedure under local anesthetic, the patient is placed in a sitting position and eyelid height and contour are evaluated under the effect of gravity. The amount that the levator tendon is advanced corresponds to the degree of preoperative ptosis. If the patient is not able to undergo the procedure under local anesthetic, general anesthesia is used and a predetermined amount of advancement is performed. In either case, the incision is repaired with sutures once the tendon has been secured in its new location.

Hope that helps.

F Tessa Bartels, CPC, CEMC

[mdunn]

I have an op note with both of these procedures documented as being performed. They are bundled but a modifier is allowed. If both procedures were performed bilaterally is there ever an instance it would be appropriate to apply modifier 59 to 15823?

[CVR]

I only report the more extensive procedure that corrects the problem....67904.