Advanced Search

Ophthalmology and Optometry Coding Alert

Quick Key:

11 Ways to Show Medical Necessity for Ptosis Repair

Published on Sun Aug 28, 2005

Pick the right ICD-9 code to show your carrier that eyelid procedures aren't cosmetic Although each carrier may have its own LCD outlining which diagnoses support medical necessity for blepharoptosis repair procedures (67901-67908, Repair of blepharoptosis...), here are 11 ICD-9 codes that will typically do the trick.
   374.30 - Ptosis of eyelid, unspecified
   374.31 - Paralytic ptosis
   374.32 - Myogenic ptosis
   374.33 - Mechanical ptosis
   374.34 - Blepharochalasis
   374.87 - Dermatochalasis
   374.89 - Other disorders of eyelid
   743.61 - Congenital ptosis
   743.62 - Congenital deformities of eyelids
   743.63 - Other specified congenital anomalies of eyelid
   V52.2 - Fitting and adjustment of artificial eye. Sources: LCDs from Anthem Blue Cross and Blue Shield, Blue Cross and Blue Shield of Alabama, Blue Cross and Blue Shield of Kansas, Cahaba Government Benefit Administrators, CIGNA Government Services, Noridian Administrative Services, and Wisconsin Physicians Service Insurance Corp.
You’ve reached your limit of free articles. Already a subscriber? Log in.
Not a subscriber? Subscribe today to continue reading this article. Plus, you’ll get:
  • Simple explanations of current healthcare regulations and payer programs
  • Real-world reporting scenarios solved by our expert coders
  • Industry news, such as MAC and RAC activities, the OIG Work Plan, and CERT reports
  • Instant access to every article ever published in Revenue Cycle Insider
  • 6 annual AAPC-approved CEUs
  • The latest updates for CPT®, ICD-10-CM, HCPCS Level II, NCCI edits, modifiers, compliance, technology, practice management, and more

Other Articles in this issue of

Ophthalmology and Optometry Coding Alert

View All