Ophthalmology and Optometry Coding Alert

Try your hand at coding these procedures, and then compare your answers with our experts’.

Blepharoptosis repair procedures can bring a lot of revenue into your practice, but coding them can be fraught with danger. Payers are looking for reasons to deny your claim, in the absence of evidence that the ophthalmic surgeon performed the procedure for medical necessity, not cosmetic, reasons. And you may need to study the operative note carefully before you can tell just which oculoplastic procedure your surgeon performed. 

To correctly code oculoplastic surgery on eyelids, you need detailed information about the surgical techniques the ophthalmologist used, as well as the specific anatomic sites involved. Getting a single detail wrong could prove costly to your practice.

Many of the blepharoptosis repair codes (67901-67908, Repair of blepharoptosis ...) describe procedures that seem almost identical. There are key differences, however, that will help you choose the correct code for the procedure your ophthalmologist performed, experts say.

Beware: Adding to the difficulty is the fact that Medicare often questions the medical necessity of oculoplastic procedures, especially blepharoptosis repair, experts say. Codes 67901-67911 represent procedures that physicians may also perform strictly for cosmetic purposes and because of this Medicare may question whether to cover these procedures. Be sure your documentation includes relevant medical history, visual field test results, external photographs, and physical examination records. Check with your local carrier for any additional specific requirements when providing oculoplastic services.

Question 1: Frontalis Fixation

The ophthalmologist performs a technique to repair blepharoptosis by suspending the eyelid from the frontalis muscle above the eyelid. Prior to surgery, the physician confirms the surgical site and marks the planned incisions with a pen. After anesthetic is delivered, the physician places a traction suture through the upper eyelid margin and clamps it inferiorly. He then makes the necessary incisions in the eyelids and the brow. If the physician is using banked fascia as a sling, he uses a fascia needle to thread the fascia between the incisions. He secures the fascia or suture material after achieving optimal eyelid height and contour, and closes the incisions in layers. How would you code this procedure?

Question 2: Frontalis Fixation With Fascial Sling

The procedure makes use of a graft of fascia, usually obtained from the patient’s thigh. Prior to surgery, the physician confirms the surgical site and marks the planned incisions with a pen. He also harvests the fascia from the patient’s thigh and prepares the graft for use in the blepharoptosis repair. After anesthetic is delivered, the physician places a traction suture through the upper eyelid margin and clamps it inferiorly. He then makes the necessary incisions in the eyelids and the brow. If the physician is using banked fascia as a sling, he uses a fascia needle to thread the fascia between the incisions. He secures the fascia or suture material after achieving optimal eyelid height and contour, and closes the incisions in layers. How would you code this procedure?

Question 3: Levator Resection, Internal Approach

The surgery shortens the tendon of this muscle and effectively elevates the eyelid. The surgeon takes an internal approach to the levator muscle, through the conjunctiva. The physician everts the eyelid (i.e., turns it inside–out) and resects the levator tendon through the conjunctiva. How would you code this procedure?

Question 4: Levator Resection, External Approach

The surgery shortens the tendon of this muscle and effectively elevates the eyelid. The surgeon takes an external approach, creating an incision in the fold of the upper eyelid through which he accesses the levator tendon. He then resects or advances the tendon to correct the eyelid’s drooping. How would you code this procedure?

Question 5: Superior Rectus Sling

The physician uses the superior rectus muscle, which is attached to the outside of the eyeball, to suspend the drooping eyelid. He attaches the eyelid to the superior rectus muscle with a sling made of fascia obtained from the patient. How would you code this procedure?

Question 6: Fasanella Procedure

This procedure involves resection and plication of the levator/Muller muscles along with the tarsus and the conjunctiva. The surgeon resects the Muller’s muscle along with a portion of the tarsus and conjunctiva. One millimeter of tarsus is resected for each millimeter of ptosis. The levator muscle may also be resected if needed to achieve normal lid position. How would you code this procedure?

Read on to see if you’ve picked the correct CPT® codes for these procedures.