Ophthalmology and Optometry Coding Alert

Question: Parents brought in a 4-year-old patient referral presenting with ptosis of the right eyelid. The ptosis was so pronounced that the lid occluded the pupil. Our doctor performed a blepharoplasty (15823) and a levator repair (67904). Are these two procedures bundled, or should I report them separately?
      
Florida Subscriber

Answer: Coding for blepharoplasty (15823, Blepharoplasty, upper eyelid; with excessive skin weighting down lid) and a levator repair (67904, Repair of blepharoptosis; [tarso] levator resection or advancement, external approach) can be tricky.
    
Since the child's vision is affected, carriers will consider this procedure medically necessary.
 
A blepharoplasty, an excision of skin and fat, and levator repair, an excision of muscle, can sometimes confuse coders when both procedures are done at the same time. The National Correct Coding Initiative considers codes 15823 and 67904 bundled.
 
In your example, the patient is a 4-year-old and should be covered by the parent's insurance. You should definitely report both procedures and send a paper claim with a copy of the operative report.