Wiki 67840 question

[cherylbr]

Can someone please help me with coding for the following:
67840
RUL X 3
LUL X 1
LLL X 2
The patient has Aetna insurance.

I'm confused if the code is reported once per eyelid or multiple times for more than one lesion per eyelid.

Please help!
Thank you,
Cheryl

 

[SharonCollachi]

67840 is per eyelid.

 

[arosario@ocalaeye.com]

If it is per eyelid than why is the MUE 3?

 

[SharonCollachi]

My response was per the American Academy of Opthalmology, here (click me):

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Question: Our surgeon performed CPT code 67840 Excision of lesion of eyelid. However, the surgeon removed multiple lesions. Shouldn’t this be submitted as CPT code 67801 Excision of chalazion multiple same lid? The procedure note states: Excision of multiple lid lesions left eyelid - left upper eyelid, left temporal, center, top inferior and bottom inferior?​

Answer: CPT code 67840 applies per eye, no matter how many lesions are removed. This code includes the language other than chalazion. If indeed the lesions were chalazia, then, CPT code 67801 is correct.

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Here (click me) is another discussion of the same code, where money was recouped on overbilling of this code:

Answer from the expert, E. Ann Rose, Rose and Associates. Code 67840 is payable per session/per eye. Since lesions were removed from both eyelids of both eyes (regardless of the number of lesions removed), you should bill 67840-50. Just want to show you something from AAO that verifies my answer as well: Case#4 Scenario: The payer audited 15records of CPT code 67840 Excision of lesion of eyelid (except chalazion) without closure or with simple direct closure. In order to use this code, removal must include more than skin (i.e., involving lid margin, tarsus and/or palpebral conjunctiva). On each of the 15 charts, the surgeon has removed the multiple lesions on the upper and lower lids of the same eye. The typical claim submitted was: 67840-E1 = $276; 67840-59-51-E1 = $138 (50 percent reduction); 67840-51-E2 = $138 (50 percent reduction). Error: CPT code 67840 is payable per eye, not per lid or lesion, resulting in an overpayment of $276 per claim x15 ($4,140 total), but that’s not the worst of it. Chart documentation did not warrant that level of service, and all 15 charts were down-coded to CPT code 11440 Excision, other benign lesion, including margins, except skin tag, eyelids. CPT code 11440 is payable per session, not per lesion, lid, or eye.