Ophthalmology and Optometry Coding Alert

Code Blepharoplasty First in ASC Question: Our oculoplastic surgeon performed levator resection and blepharoplasty on both upper eyelids in the same surgical session. Can I code these procedures together (15823 and 67904), or are they considered bundled? Which one should I code as the primary procedure?
Indiana Subscriber
Answer: The codes--15823 (Blepharoplasty, upper eyelid; with excessive skin weighting down lid) and 67904 (Repair of blepharoptosis; [tarso] levator resection or advancement, external approach)--are not bundled, so you can report them together. Remember that Medicare considers both procedures inherently unilateral, so if the oculoplastic surgeon performs them on both upper eyelids, you will need to append modifier 50 (Bilateral procedure). Which code to report as primary depends on the type of facility where you perform the procedure. Generally, you should code the procedure with the most relative value units first. In a fully implemented facility (such as a hospital or ambulatory surgery center), the 2006 Physician Fee Schedule assigns more RVUs to 15823 (13.99) than 67904 (11.91). But in a nonfacility, the fee schedule assigns 16.32 RVUs to 67904, but only 15.41 to 15823. So if the oculoplastic surgeon performed the surgery in the office, report 67904-50 first and 15823-50-51 (Multiple procedures) second.