Ophthalmology and Optometry Coding Alert

How did you do with our 6 surgical scenarios?

Were you able to select the appropriate CPT® codes for these six belpharoptosis repair scenarios?

Answer 1: Frontalis Fixation

AKA: Frontalis suspension, frontalis sling

Code: 67901 (... frontalis muscle technique with suture or other material [e.g., banked fascia])

Look for: The key to this procedure is the phrase suture or other material in the code description. In this procedure, the ophthalmologist passes a needle equipped with threadlike material through incisions in the brow and eyelid, creating a sling to support the drooping eyelid. Possible suture materials include preserved and autogenous fascia lata, #40 silicone bands, silicone rods, and prolene sutures.

This is also the highest-valued of the 67901-67908 codes. The Physician Fee Schedule assigns 67901 22.13 RVUs; multiplied by the 35.8228 conversion factor, this leads to $792.76 in reimbursement before applying geographic adjustments.

Answer 2: Frontalis Fixation With Fascial Sling

AKA: Frontalis suspension

Code: 67902 (... frontalis muscle technique with fascial sling [includes obtaining fascia])

Look for: This procedure is almost exactly the same as that for code 67901. The difference? The ophthalmologist uses a sling of fascia lata —  thin fibrous tissue from the thigh —  to suspend the drooping eyelid. He may also use irradiated fascia taken from cadavers. Only use 67902 if you confirm that the ophthalmologist used fascia lata tissue.

Don’t miss: The description for 67902 states, “includes obtaining fascia.” You shouldn’t have a separate code — for example, from the 20000 section of the CPT® code book — for the harvesting of the fascia, which is included in the description and payment of the procedure.

Answer 3: Levator Resection, Internal Approach

AKA: Tarsolevator resection, tarsolevator advancement

Code: 67903 (... [tarso] levator resection or advancement, internal approach)

Look for: The approach is the key for 67903. To report 67903, you have to have documentation that the eyelid was turned inside out, and the surgical approach was literally from the conjunctival side. The ophthalmologist accesses the levator aponeurosis (a fanlike extension of the levator muscle) through the conjunctiva, and either resects or advances the tissue to correct the drooping.

Answer 4: Levator Resection, External Approach

AKA: Tarsolevator resection, tarsolevator advancement

Code: 67904 (... [tarso] levator resection or advancement, external approach)

Look for: As with 67903, the approach is the key for 67904. In this case, the ophthalmologist resects or advances the levator through an incision into the eyelid fold.

Hidden trap: Be careful — because this may be the approach that you see most often, you don’t want to inappropriately assign this code in the rare chance that it’s actually an internal approach procedure.

Answer 5: Superior Rectus Sling

Code: 67906 (... superior rectus technique with fascial sling [includes obtaining fascia])

Look for: The ophthalmologist uses the superior rectus muscle, which is attached to the outside of the eyeball, to suspend the drooping eyelid. Note that like 67902, the description for this code tells you that obtaining the fascia is included — do not code separately for that.

However: Don’t expect to see too many of these. This procedure runs the risk of reducing the function of the superior rectus muscle, so ophthalmologists do not perform it often.

Answer 6: Fasanella Procedure

AKA: Conjunctivo-tarso-Muller’s muscle-levator resection, internal tarsoconjunctival Mullerectomy

Code: 67908 (... conjunctivo-tarso-Muller’s muscle-levator resection [e.g., Fasanella-Servat type])

Look for: As he does in 67903, the ophthalmologist performing 67908 turns the eyelid inside out. There will usually be some reference to a clamp in the operative note, since the procedure involves clamping the superior tarsal border. The operative notes may also refer to the removal of the tarsus, conjunctiva, levator aponeurosis and Muller’s muscle all at once.