Anesthesia Coding Alert

Question: My physician often provides anesthesia for eye procedures. When a senile ectropion is diagnosed (code 374.11), a lateral wedge resection is performed (67916, Repair of ectropion; blepharoplasty, excision tarsal wedge). The procedure code crosses to anesthesia code 00103 (Anesthesia for reconstructive procedures of eyelid [e.g., blepharoplasty, ptosis surgery), but the claim is denied because code 374.11 is not on Medicare's list of acceptable diagnoses for anesthesia code 00103. How should I code for the procedure?

North Dakota Subscriber

Answer: Surgical code 67916 does cross to anesthesia code 00103, but it also crosses to 00140 (Anesthesia for procedures on eye; not otherwise specified). Using that as your anesthesia billing code will simplify reimbursement since you are obligated to use a code appropriate for diagnosis 374.11. Reimbursement should also be easier since you are treating a diagnosis of ectropion (which is a noncosmetic condition that should be reimbursed without delay) instead of ptosis (374.30, Ptosis of eyelid, unspecified), which is considered a cosmetic condition (and is harder to obtain reimbursement for) unless you have documentation of the patient's visual field loss.

You Be the Coder and Reader Questions were reviewed by Barbara J. Johnson, CPC, MPC, professional coder at Loma Linda University Anesthesiology Medical Group Inc., an anesthesia physician group in Loma Linda, Calif.