Ophthalmology and Optometry Coding Alert

Question: Our physician removed xanthelasma from all four lids. There was extensive muscle dissection the xanthelasma had invaded the underlying orbicularis muscle on all lids. Nasal fat was also removed. Should I use blepharoplasty codes? Arizona Subscriber Answer: For excision of the xanthelasma on the upper lids, report 11442 (Excision, other benign lesion [unless listed elsewhere], face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 1.1 to 2.0 cm) or 11443 ( lesion diameter 2.1 to 3.0 cm) depending on size, appended with -E1 (Upper left, eyelid) and -E3 (Upper right, eyelid). Then for the rotational flap reconstruction of the upper lids, use 14060 twice (Adjacent tissue transfer or rearrangement, eyelids, nose, ears and/or lips; defect 10 sq cm or less), once with modifier -E1 and once with modifier -E3. For the lower lids, report blepharoplasty code 15821 (Blepharoplasty, lower eyelid; with extensive herniated fat pad) with modifier -E2 (Lower left, eyelid) and 15821 with modifier -E4 (Lower right, eyelid). No code exists for dissection of the orbicularis muscle. The fat removal is bundled with the blepharoplasty.