Ophthalmology and Optometry Coding Alert

Question: The ophthalmologist removed six lesions from a patient's right upper eyelid in February. In March, he removed six more - three from the right lower eyelid and three from the left upper eyelid. All of the lesions were less than 0.5 cm in diameter. What is the proper way to code this? Can I code six separate lesion removals in February and six in March?


Illinois Subscriber


Answer: You may code and bill for all 12 lesions. Report one unit of 11440 (Excision, other benign lesion including margins [unless listed elsewhere], face, ears, eyelids, nose, lips, mucous membrane; excised diameter 0.5 cm or less) for each lesion, no matter when the ophthalmologist removes them - or which eyelid he removes them from. Report with both modifier -51 (Multiple procedures) and -E3 (Upper right, eyelid) on separate lines of the claim form.

The real challenge in coding multiple lesion removals, however, is determining which modifier to append. Some carriers want you to use modifier -51, although most Medicare carriers will automatically append it for you. Other carriers want the eyelid modifiers E1-E4. Some want both. Ask your carrier for  its preference.