Reviewed May 18, 2015
Integumentary codes or eyelid excision code? Picking the wrong one could cost you more than $500 When an ophthalmologist removes lesions from a patient's eyelids, the coder is faced with a classic dilemma. Is it purely an integumentary procedure, reported with a code from the 1144x series (Excision, other benign lesion including margins except skin tags [unless listed elsewhere], face, ears, eyelids, nose, lips, mucous membrane) - or is it an eyelid surgery procedure, 67840 (Excision of lesion of eyelid [except chalazion] without closure or with simple direct closure)?
The answer, and the path to accurate and profitable coding, depends on the number, location, type and size of the lesions. Following are several real-life coding scenarios to help you make the right choice next time.
Don't forget: Check with your carriers to see which modifiers they need to see when you're reporting multiple lesion removals, says Paulette Aaronson, CPC, senior coder for Ophthalmic Consultants of Boston. Depending on the carrier, you may need to append an eyelid modifier (-E1, Upper left, eyelid; -E2, Lower left, eyelid; -E3, Upper right, eyelid; or -E4, Lower right, eyelid) or modifier -51 (Multiple procedures) - or perhaps even both. Scenario 1: 1 Lesion, 1 Eyelid The ophthalmologist removes one lesion from the upper left eyelid. The excised skin measures 0.8 cm in diameter, and the pathology report shows that it's benign.
Coding: Code 67840 not only accurately describes the ophthalmologist's work but also brings more reimbursement than the applicable skin code, 11441 (... excised diameter 0.6 to 1.0 cm). Code 67840's 7.75 RVUs will bring $277.10 to a nonfacility, over $100 more than 11441 (4.48 RVUs x 35.7547 conversion factor = $170.19). The pricing for 67840 takes into account the difficulty of working around the eye compared to other parts of the body.
Key: To be able to report 67840, the ophthalmologist has to remove more than just skin, says Renee Adkins, CPC, administrative assistant and coder for the oculoplastics department at Minnesota Eye Associates in Bloomington. In the introduction to the eyelid excision codes, the
CPT manual states that the codes include procedures ""involving lid margin, tarsus and/or palpebral conjunctiva."" Scenario 2: 4 Lesions, 1 Eyelid The ophthalmologist removes four benign lesions from the lower right eyelid. All of the lesions are less than 0.5 cm in diameter.
Coding: While 67840 would work here, 11440 (... excised diameter 0.5 cm or less) is a better choice. Since 67840 is an excision code, which is billed by the lid, you can't report it with units, Aaronson says - unlike the integumentary codes. Report 11440 on the first line and 11440-51 [...]
