Ophthalmology and Optometry Coding Alert

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Show Medical Necessity for Ptosis Repair

Although each carrier may have its own LMRP outlining which diagnoses support medical necessity for blepharoplasty and brow repair procedures, this list shows many of the ICD-9 codes typically accepted.

 172.1 - Malignant melanoma of skin of eyelid, including canthus

 173.1 - Other malignant melanoma of skin of eyelid, including canthus

 190.1 - Malignant neoplasm of orbit

 216.1 - Benign neoplasm of eyelid, including canthus

 216.3 - Benign neoplasm of skin of other and unspecified parts of face

 232.1 - Carcinoma in situ of eyelid, including canthus

 333.81 - Blepharospasm

 351.0 - Bell's palsy

 351.9 - Facial nerve disorder, unspecified

 368.40 - Visual field defect, unspecified

 373.00-373.34 - Inflammation of eyelids

 374.00-374.23 - Other disorders of eyelids

 374.30 - Ptosis of eyelid, unspecified

 374.31 - Paralytic ptosis

 374.32 - Myogenic ptosis

 374.33 - Mechanical ptosis

 374.34 - Blepharochalasis

 374.41 - Lid retraction or lag

 374.43 - Abnormal innervation syndrome of eyelid

 374.46 - Blepharophimosis

 374.82-374.89 - Other disorders of eyelid 

 376.21 - Thyrotoxic exophthalmos

 378.51 - Third or oculomotor nerve palsy, partial

 378.52 - Third or oculomotor nerve palsy, total

 701.8 - Other specified hypertrophic and atrophic conditions of skin

 743.00 - Clinical anophthalmos, unspecified

 743.61 - Congenital ptosis of eyelids

 743.62 - Congenital deformities of eyelids

 743.63 - Other specified congenital anomalies of eyelid

 V45.78 - Acquired absence of organ, eye

 V52.2 - Fitting and adjustment of artificial eye
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