Advanced Search

Ophthalmology and Optometry Coding Alert

Quick Key:

Show Medical Necessity for Blepharoplasty: Here's How

Published on Mon Jan 28, 2008

Diagnosis of a medical problem helps prove that eyelid procedure wasn't cosmetic.Each carrier may have its own LCD outlining which diagnoses support medical necessity for blepharoplasty procedures 15822 (Blepharoplasty, upper eyelid) or 15823 (... with excessive skin weighting down lid). But if one of these ICD-9 codes that carriers often consider medically necessary legitimately describes your patient's condition, you're a long way toward demonstrating the eyelid surgery wasn't for looks.
• 373.4 -- Infective dermatitis of eyelid of types resulting in deformity
• 373.5 -- Other infective dermatitis of eyelid
• 373.6 -- Parasitic infestation of eyelid
• 374.30-374.34 -- Ptosis of eyelids
• 374.89 -- Other disorders of eyelid
• 743.61 -- Congenital ptosis of eyelid
• 743.62 -- Congenital deformities of eyelid
• 743.63 -- Other specified congenital deformities of eyelid
• V52.2 -- Fitting and adjustment of artificial eye.Note: Be sure to check with the insurers for any LCDs they might have for 15822 or 15823.
You’ve reached your limit of free articles. Already a subscriber? Log in.
Not a subscriber? Subscribe today to continue reading this article. Plus, you’ll get:
  • Simple explanations of current healthcare regulations and payer programs
  • Real-world reporting scenarios solved by our expert coders
  • Industry news, such as MAC and RAC activities, the OIG Work Plan, and CERT reports
  • Instant access to every article ever published in your eNewsletter
  • 6 annual AAPC-approved CEUs*
  • The latest updates for CPT®, ICD-10-CM, HCPCS Level II, NCCI edits, modifiers, compliance, technology, practice management, and more
*CEUs available with select eNewsletters.

Other Articles in this issue of

Ophthalmology and Optometry Coding Alert

View All