Ophthalmology and Optometry Coding Alert

Question: Can an ASC charge be submitted for 15823?

Bonnie Gibbs
Montgomery Eye Center
Naples, FL

Answer: The answer is yes, but you need to make the same provisions that you would make for performing this procedure, which is for blepharoplasty of the upper eyelid with excessive skin weighting down the lid. If the procedure is being done in an ambulatory surgery center (ASC), you can bill an ASC charge, but in order to get paid, make sure you have done visual fields (92081-92083) and external photos (92285). Also, this procedure is usually done bilaterally. Since 15823 (blepharoplasty, upper eyelid; with extensive skin weighting down lid) is a unilateral code, you need to bill a modifier -50 to indicate that it is being done on both eyes, if in fact the procedure is done on both.

Note: In order to bill Medicare an ASC fee, you must be a Medicare-certified ASC. Some ASCs are freestanding buildings that are not owned and operated by a hospital, and some are owned and operated by a hospital. In either case, these surgeries are considered outpatient procedures performed in an ASC place of service.

Sources for reader questions: Lise Roberts, vice president, Healthcare Compliance Strategies, Syosset, NY; Kitty Timmes, COMT, office manager, Joseph J. Timmes Jr., MD, FACS, Annandale, VA; Angela Spurlin, billing manager, Jacksonville Eye Clinic, Jacksonville, NC.