AAPC - Back to school
Results 1 to 5 of 5

Thread: 67904 with 15823

  1. #1
    Join Date
    Apr 2007

    Default 67904 with 15823

    AAPC: Back to School
    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
    Join Date
    Apr 2007


    That is what I thought. Thanks for your help.


  4. #4


    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. #5


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

Similar Threads

  1. 15823 with 67904
    By niurkasilva@yahoo.com in forum Ophthalmology/Optometry
    Replies: 6
    Last Post: 08-30-2015, 08:40 PM
  2. 15823 and 67904 on same eye - We have patients
    By ms123 in forum Ophthalmology/Optometry
    Replies: 3
    Last Post: 04-06-2015, 10:41 AM
  3. 15823 and 67904 on same eye
    By ms123 in forum Outpatient Facilities
    Replies: 0
    Last Post: 12-11-2012, 02:17 PM

Posting Permissions

  • You may not post new threads
  • You may not post replies
  • You may not post attachments
  • You may not edit your posts

Enjoying Our Forums?

AAPC forums are a benefit of membership. Joining AAPC grants you unlimited access, allowing you to post questions and participate with our community of over 150,000 professionals.

Join Now Continue Reading Without Full Access

Already a Member?


Close Message

In addition to full participation on AAPC forums, as a member you will be able to:

  • Access to the largest healthcare job database in the world.
  • Join over 150,000 members of the healthcare network in the world.
  • Be a part of an industry leading organization that drives the business side of healthcare.
  • Save anywhere from 10%-50% with exclusive member discounts on courses, books, study materials, and conferences.
  • Access to discounts at hundreds of restaurants, travel destinations, retail stores, and service providers. AAPC members also have opportunities to save on heath, life, and liability insurance.
  • Become a member of a local chapter and attend regular meetings.