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67904 with 15823

  1. #1
    Default 67904 with 15823
    Medical Coding Books
    Is 15823 bundled with 67904? Doc office wants to charge pt for bleph and bill ins for levator. Not sure if we can to this.


  2. #2
    15823 is mutually exclusive to 67904 however a modifier is allowed. (like if it is on the other eye.)

  3. #3
    That is what I thought. Thanks for your help.


  4. Default
    I disagree, you should be able to bill both as long as both are documented. See below from August 2011 issue of CPT assistant.


    The CPT Assistant Newsletter (September 2000; p 7) cited the following regarding the reporting of blepharoplasty and blepharoptosis:

    The fundamental difference between the blepharoplasty and the blepharoptosis repair is that a blepharoplasty is surgery on the skin of the upper eyelid and the orbital fat, while a blepharoptosis repair is surgery on the levator muscle of the eyelid. These procedures may either be done independently or together on the same eye depending upon the surgical indication. This would occur when the upper eyelid has redundant skin and the levator muscle is unable to elevate the eyelid to the normal position. When these two procedures are done on the same upper eyelid, both procedural codes are needed to accurately describe the procedure. The coder should include the multiple procedures Modifier 51 with the second code.


    The instruction reported in the September 2000 issue of the CPT Assistant Newsletter remains correct, ie, it is still appropriate to report code 15823, Blepharoplasty, upper eyelid; with excessive skin weighting down lid, in addition to code 67904, Repair of blepharoptosis; (tarso) levator resection or advancement, external approach, when both procedures are performed on the same eyelid. It is also appropriate to append modifier 51, Multiple Procedures, to the second code.

    Third-party payer guidelines may, however, differ from CPT coding guidelines, as both coverage and payment policy is determined by individual insurers and third-party payers. For reimbursement or third-party payer policy issues, please contact the applicable payer. "

    Lorrae Aker, CPC

  5. Default
    Depending on your carrier
    if following CCI just 67904 (unless other eye) some commercials may allow both if following AMA's 2011 directive.

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