Ophthalmology and Optometry Coding Alert

Question: How should we code for removing gold weights from the eyelids? We have a difference of opinion and can't decide whether to bill this as foreign-body removal or as an unlisted procedure.

Ohio Subscriber

Answer: The most appropriate code to bill for removal of gold weights is CPT code 67999 (Unlisted procedure, eyelids). The gold weights are considered implants, not foreign bodies, since a physician placed them there deliberately to correct the inability to fully close the eyelid.

In 2004, CPT introduced 67912 (Correction of lagophthalmos, with implantation of upper eyelid lid load [e.g., gold weight]) but has yet to address gold-weight removal with a specific code.

Key: Remember that when you bill using an unlisted-procedure code, you need to include the operative report to describe the service. It's also a good idea to include a letter describing, in plain English, what the ophthalmologist did. You can also compare the procedure to an existing CPT code - for instance, 67938 (Removal of embedded foreign body, eyelid) - with an established reimbursement value.

- Advice for You Be the Coder and Reader Questions provided by Maggie M. Mac, CMM, CPC, CMSCS, consulting manager for Pershing, Yoakley & Associates, Clearwater, Fla; and Raequell Duran, president of Practice Solutions, Santa Barbara, Calif.