AAPC - July Freedom Sale

Results 1 to 4 of 4

Thread: 15823 and 67904 on same eye

  1. #1
    Join Date
    Apr 2007
    Location
    York, PA
    Posts
    59

    Default 15823 and 67904 on same eye

    We have patients who have the levator resection (67904) and the excision of excess skin/fat (15823) done on the SAME EYE. For Medicare, there is an NCCI bundle, so only one code can be submitted. 15823 has the higher RVU, thus that one should be coded for Medicare, correct? But for COMMERCIAL payers, can both 15823 59 and 67904 59 be submitted? Is there a policy stating any of this?

    Any response will be greatly appreciated.
    Thank you.

  2. #2
    Join Date
    Apr 2007
    Location
    Hollywood, CA
    Posts
    98

    Default

    http://codingnews.inhealthcare.com/c...r-15823-67904/


    Should help you with your question
    Sal Valdepena, CCS, CEDC

  3. #3
    Join Date
    Apr 2007
    Location
    Columbia, MO
    Posts
    12,027

    Default

    since most if not all commercial payers also follow the CCI edits then I would say no you cannot bill both, you are allowed to bill the procedure with the higher RVU, but be sure you have it correct.

    Debra A. Mitchell, MSPH, CPC-H

  4. #4

    Default

    2017 ICD-10-CM Coding Book
    I disagree, you should be able to bill both as long as both are documented. See below from August 2011 issue of CPT assistant.

    "THEN

    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.

    NOW

    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

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. 67904 with 15823
    By CVelez in forum Outpatient Facilities
    Replies: 4
    Last Post: 04-08-2015, 01:32 PM
  3. 15823 and 67904 on same eye
    By ms123 in forum Outpatient Facilities
    Replies: 0
    Last Post: 12-11-2012, 02:17 PM
  4. 15823 and 67904 on same eye
    By ms123 in forum Medical Coding General Discussion
    Replies: 0
    Last Post: 12-11-2012, 02:16 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?

Login

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.