# Help on Eyelid biopsy



## jelms (Nov 5, 2012)

Hello,  I am a new coder in ophthalmology and have been presented with a case of excisional biopsy eyelid lesions to code.  I was wondering if someone here would be able to help me code this operative report as I do not have much experience in biopsy 

Path Report Shows:
A: FS, Right Upper Lid pigmented lesions x2 =   Lentigo/Hyperpigmentation
B: Additional Right Upper Lid=  Post inflammatory hyperpigmentation
C: Pigmented Left Upper Lid=  Lentigo w/ atypical melanocytic hyperplasia

Surgical Report:
PROCEDURE:  He was taken to the operating room and  
positioned in the supine position.  A drop of tetracaine  
was applied to each eye and he was prepped and draped in  
the usual fashion.  Metallic corneal shields with  
Celluvisc were inserted bilaterally.  Throughout the  
procedure, he received a total of 1 mL of 2% lidocaine  
with 1:100,000 epinephrine into the upper eyelids.   
Westcott scissors were used to obtain biopsy specimens  
from the right side.  This was sent for the frozen section  
and came back as listed above.  The pigment was very  
superficial and the rest of the pigmented area was  
debrided with a #15 Bard-Parker blade.  The left upper  
eyelid pigmented area was excised and sent in separate  
formalin container for permanent section.  Additional  
specimen from the right upper eyelid edge was also sent  
directly for permanent section.  Bipolar cautery was used  
for hemostasis.  Erythromycin ung was applied but no  
bandages.  Instructions were given.  He tolerated the  
procedure well and left the operating room in good  
condition.  


Thanks..


----------



## grth97 (Nov 23, 2012)

67810  
Biopsy of eyelid  

Coding Tips      

 This is a unilateral procedure. If performed bilaterally, some payers require that the service be reported twice with modifier 50 appended to the second code while others require identification of the service only once with modifier 50 appended. Check with individual payers. Modifier 50 identifies a procedure performed identically on the opposite side of the body (mirror image). When 67810 is performed with another separately identifiable procedure, the highest dollar value code is listed as the primary procedure and subsequent procedures are appended with modifier 51. If multiple areas are biopsied, report 67810 for each site taken and append modifier 59 Distinct procedural service, to additional codes. Surgical trays, A4550, are not separately reimbursed by Medicare; however, other third-party payers may cover them. Check with the specific payer to determine coverage.


----------

