Medicare Compliance & Reimbursement

Question: How would I code for insertion of gold eyelid weights to correct lagophthalmos? Is there a code for the supply of the gold weights themselves?

Answer: Report CPT® code 67912 (Correction of lagophthalmos, with implantation of upper eyelid lid load [e.g., gold weight]) for the insertion of the gold eyelid weights. Ophthalmologists sometimes weigh down a patient's upper eyelids to correct lagophthalmos, which is the inability to close the eye completely. Untreated, the condition could lead to abrasions, infections and corneal drying.

When Medicare developed the new code for this procedure in 2004, the expectation was that reimbursement included the gold weight supply. With 25.21 non-facility RVUs in the 2011 fee schedule, 67912 should bring approximately $856.55 into your practice (after multiplying the RVUs by the 33.9764 conversion factor). For non-Medicare payers, you may be able to bill the gold weights with L8610 (Ocular implant) and attach an invoice showing the actual cost by the vendor, to the claim form. However, most payers follow Medicare's policy and include the gold weight supply in the global surgery reimbursement.

Don't miss: When the ophthalmologist implants both lids with gold weights, append modifier 50 (Bilateral procedure) to 67912. Reimbursement should be at 150 percent for both lids. Be sure to include the specific lagophthalmos diagnosis (374.21, Paralytic lagophthalmos) in your claim.