Ophthalmology and Optometry Coding Alert

Diagnosis of a medical problem helps prove that eyelid procedure wasn't cosmetic.

Each carrier may have its own LCD outlining which diagnoses support medical necessity for blepharoplasty procedures 15822 (Blepharoplasty, upper eyelid) or 15823 (... with excessive skin weighting down lid). But if one of these ICD-9 codes that carriers often consider medically necessary legitimately describes your patient's condition, you're a long way toward demonstrating the eyelid surgery wasn't for looks.

• 373.4 -- Infective dermatitis of eyelid of types resulting in deformity

• 373.5 -- Other infective dermatitis of eyelid

• 373.6 -- Parasitic infestation of eyelid

• 374.30-374.34 -- Ptosis of eyelids

• 374.89 -- Other disorders of eyelid

• 743.61 -- Congenital ptosis of eyelid

• 743.62 -- Congenital deformities of eyelid

• 743.63 -- Other specified congenital deformities of eyelid

• V52.2 -- Fitting and adjustment of artificial eye.

Note: Be sure to check with the insurers for any LCDs they might have for 15822 or 15823.