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