Ophthalmology and Optometry Coding Alert

Question: Which CPT code should I use for eyelid gold weight implantation?

Texas Subscriber  
Answer: There is no specific code for gold weight implantation. The closest code in description is 67911 (correction of lid retraction). However, this code does not cover the implanting of the gold weights, which involves more work. Code 67911 generally pays $1,300, while the fee for gold weight implantation is double that.
 
Gold weights are used to close the lid when it will not close, due to seventh-nerve palsy, Bells palsy, or palsy secondary to an acoustic neuroma, for example. The procedure is medically necessary if the lid cant close on its own and exposure keratitis ensues. The procedure is usually done unilaterally. Medicare and commercial payers cover this procedure.
 
The best code to use is an unlisted eyelid procedure code (67999). The gold weights should be billed to payers other than Medicare with supply code (99070) with the invoice attached. The hospital or the ambulatory surgical center can bill Medicare for the gold weight with L8610 (ocular implant), but some ophthalmologists perform this procedure in their office on an outpatient basis. Ophthalmologists performing the procedure in their office may not be reimbursed for the gold weight supply because supplies and materials are considered bundled into the global surgery package for office-based procedures.