Ophthalmology and Optometry Coding Alert

Question: What is the best code combination for brow ptosis repair?

Florida Subscriber  
Answer: Brow ptosis is a condition in which the eyebrows droop, sometimes causing the eyelids to droop, which can cause vision loss. A browlift or browplasty involves the removal of tissue above the eyebrows. Two codes apply to browlifts.
 
Code 67900 (Repair of brow ptosis [supraciliary, mid-forehead or coronal approach]) is the most appropriate code for a direct browlift, performed for therapeutic purposes. If there is excess skin, which causes the brows to droop and interfere with vision, bill 67900. Likewise, if there is severe nerve palsy that causes visual field loss due to brow ptosis, also bill 67900 for the repair. To bill Medicare for this code, you must have documentation of medical necessity: specifically, a visual defect documented by visual fields (92081-92083), and pathology documented by external ocular photographs with side views (92285, External ocular photography with interpretation and report for documentation of medical progress [e.g., close-up photography, slit lamp photography, goniophotography, stereo-photography]).
 
Code 15824 (Rhytidectomy; forehead) is used for cosmetic browlifts. A cosmetic procedure is one performed for enhanced appearance and not for functional impairment. As opposed to 67900, which is an eye surgery code for a procedure for a functional impairment, 15824 is a plastic surgery code, which is not reimbursable. 
 
Do not use 14060 (Adjacent tissue transfer or rearrangement, eyelids, nose, ears and/or lips; defect 10 sq cm or less) for browlifts. Often known as a z-plasty, 14060 is for a plastic surgery procedure preformed to reconstruct an eyelid, as in a scar revision.