Ophthalmology and Optometry Coding Alert

Question: Our oculoplastic surgeon performed levator resection and blepharoplasty on both upper eyelids in the same surgical session. Can I code these procedures together (15823 and 67904), or are they considered bundled? Which one should I code as the primary procedure?

Indiana Subscriber

Answer: If the oculoplastic surgeon performs the blepharoplasty (bleph) with excessive weight (15823, Blepharoplasty, upper eyelid; with excessive skin weighting down lid) on one eye and the blepharoptosis (ptosis) repair (67904, Repair of blepharoptosis; [tarso] levator resection or advancement, external approach) on the other eye, you may be able to report both codes by using modifiers RT or LT and 59 (Distinct procedural service) on 15823 to designate a separate site from 67904. Otherwise, you should report only 67904.

The Correct Coding Initiative (CCI) has made 15823 and 67904 mutually exclusive, meaning Medicare believes that the two procedures would not typically be performed at the same operative session. In other words, a surgeon would either perform blepharoptosis repair or blepharoplasty, not both.

Generally, you should code the procedure with the higher relative value units first. In a fully implemented facility (such as a hospital or ambulatory surgery center), the 2012 Physician Fee Schedule assigns fewer RVUs to 15823 (16.38) than 67904 (17.74). The same is true in a nonfacility, where the fee schedule assigns 21.16 RVUs to 67904, but only 18.13 to 15823. So for your oculoplastic surgeon's services, report 67904 first on the claim.