Ophthalmology and Optometry Coding Alert

Quick Key:

11 Ways to Show Medical Necessity for Ptosis Repair

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.

  • Other Articles in this issue of

    Ophthalmology and Optometry Coding Alert

    View All