Ophthalmology and Optometry Coding Alert

Question: How should I report treatments for chalazions?

Pennsylvania Subscriber

Answer:  The answer depends on the type of "treatment" the ophthalmologist provided. If the treatment was an injection, such as Kenalog, you should report 11900 (Injection, intralesional; up to and including seven lesions) for intralesional steroid injection of a hemangioma. You would use this code for up to seven intralesional injections of any kind.

For eight or more lesions, report 11901 (... more than seven lesions).

Remember: Your carrier may also want you to append an eyelid modifier to specify the location of the injection -- for example, E3 (Upper right, eyelid). Remember to report the steroid supply with the appropriate HCPCS code (such as J3301, Injection, triamcinolone acetonide, not otherwise specified, 10 mg) as well.

Bonus: If the ophthalmologist performed a significant, separately identifiable E/M service, you can report an E/M code, such as 99212 (Office or other outpatient visit for the evaluation and management of an established patient, which requires at least two of these three key components: a problem-focused history; a problem-focused examination; straightforward medical decision-making) as well as the injection code.

Option two: If the ophthalmologist actually excises the chalazion, you should report a surgical excision code. CPT® provides three codes for chalazion excisions in the office: 67800 (Excision of chalazion; single), 67801 (... multiple, same lid) and 67805 (... multiple, different lids).