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Thread: Need help with CPT code - Does anyone know

  1. #1
    Join Date
    Apr 2007

    Default Need help with CPT code - Does anyone know

    AAPC: Back to School
    Does anyone know the correct way to code four quadrant blepharoplasty with transblepharoplasty? So far I have 15822-50

  2. #2
    Join Date
    Apr 2007


    Can you post the op note?

  3. #3
    Join Date
    Apr 2007

    Default op report

    Attention was then turned to the lids. The area of skin excision was
    marked, and the area of incision for the lower lid was marked. The
    lids were infiltrated with 1% Xylocaine with epinephrine as well as
    the orbital rim and the periosteum above the orbital rim and the
    lateral orbital rim. Both sides were handled in a similar fashion.
    Excess skin was excised. A muscle strip of 2-3 mm was excised. The
    excess fat in the upper lid was removed by isolation, elevation,
    clamping, excision, cauterization, and inspection prior to removal.
    The orbicularis muscle was then elevated with 4-pronged hooks. The
    periosteum at the orbital rim was incised from lateral to the orbital
    notch, down to the lateral orbital rim, elevated with periosteal
    elevators, and then advanced superiorly. A mark was made at 1.1 cm
    from the orbital rim. Using the Endotine drill bit and a Stryker
    electrical drill at 800 rpm, a drill hole was made and irrigated out.
    The Endotine was placed with a 5-0 PDS suture through it. After the
    Endotine was snapped into position, the 5-0 was used to grab the brow
    tissue posteriorly and tied the fat inferiorly. This was closed
    gently with 5-0 PDS. A running 6-0 subcuticular Prolene was then
    done for the upper lid.

    A skin muscle flap was elevated in the lower lid, and the contents of
    the medial, central and lateral fat pads were removed by isolation,
    elevation, clamping, excision, cauterization, and inspection prior to
    release. At the completion of the removal of the fat pads,
    hemostasis was checked for and found to be excellent. Minimal skin
    was removed from the lower lid, and closure was done with a running
    6-0 Prolene.

    A similar procedure was done on the opposite eye without difficulty.
    A head wrap was then placed. Ice compresses were kept on the eyes.

  4. #4


    What was the diagnosis code your doctor documented?
    Was there a diagnosis depicting excessive skin fold ,impairing the vision even to slight extent?
    But the words in the OP notes say about EXCESSIVE SKIN and Excessive FAT excision can validate for “the excessive skin weighing down lid” and there by merits for the code 15821 and 15823 with bilateral codes.
    From the OP notes I assume there weren’t Ectropian or Entropion involved (which need codes from EYE SECTION.)
    So evaluate whether you could assign 15821 and 15823, which should be supported by your ICD Codes. If diagnosis ICD-9 codes are not met out for these , you can not code for the excessive skin excision, the op note shows, though. Clarify with your surgeon then about the diagnosis, before assigning for sure.
    [ Have a look at this passage to get an idea:
    Blepharoplasty is generally considered a cosmetic procedure and is, therefore, not covered by insurance. However, in some cases upper lid blepharoplasty may be covered by insurance if the excessive skin is causing loss/impairment of vision. Blepharoplasty procedures are individualized to each person based on their desire, anatomy, looks and ethnicity and results may vary from person to person.

    Ptosis and Dermatochalasis can give the looks of fatigue
    and aging despite good health. Ptosis correction, in most
    cases, requires blepharoplasty of the upper lids, as well
    as tightening and shortening of the levator muscle to lift
    up the eye lid to its normal position. Excessive skin is
    removed along with bulging fat pockets, if any.

    Since most of the ptosis cases have some degree of
    impairment of peripheral vision, and their correction is a
    medical necessity, the procedure may be covered by the
    insurance. ICD-9-CM Codes That Support Medical Necessity –

    When procedure codes 15822-15823, 67900-67904, 67906, 67908, 67916-67917, and 67923-67924 are used to report blepharoplasty as described within this policy, the following diagnosis code(s) will be considered by Medicare to support medical necessity:
    Covered for:
    373.4-373.6 Infective dermatitis of eyelid of types resulting in deformity
    374.00-374.05 Entropion and trichiasis of eyelid
    374.10-374.14 Ectropion
    374.30-374.34 Ptosis of eyelid
    374.87 Dermatochalasis
    743.61 Congenital ptosis
    743.62 Congenital deformities of eyelids
    V52.2 Artificial eye
    Non-covered ICD-9-CM Code(s)
    All diagnoses not listed in the "ICD-9-CM Codes That Support Medical Necessity" section of this policy.
    HCFA National Policy
    • Establishment of national policy supercedes all previous contractor policy statements, including Local Medical Policy coverage guidelines.
    • Title XVIII of the Social Security Act, section 1862 (a) (7). This section excludes routine physical examinations.
    • Title XVIII of the Social Security Act, section 1862 (a) (1) (A). This section allows coverage and payment for only those services that are considered to be medically reasonable and necessary for the diagnosis or treatment of illness or injury or to improve the functioning of a malformed body member.
    Reasons for Denial
    • The service does not follow the guidelines of this policy.
    • The medical record does not verify that the service described by the HCPCS code was provided.
    • This service will not be covered in any place of service not identified under "Indications and Limitations of Coverage."
    • Lack of supporting documentation in the medical record to reflect the medical necessity for the performance of the procedure will result in denial of the service.
    • Blepharoplasty is considered cosmetic and non-covered under the Medicare program when performed to improve appearance in the absence of any signs and/or symptoms of functional abnormalities except when required for the repair of accidental injury or for the improvement of the functioning of a malformed body member. (Social Security Act §1862 (a)(10))
    • Lower lid blepharoplasty is generally not reimbursable, since it is usually performed for cosmetic purposes.

    ©CPT American Medical Association

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