Ophthalmology and Optometry Coding Alert

Question: We had a patient who presented with a basal cell carcinoma of the right-upper lid. This tissue was removed from the eyelid and was filed using CPT code 11641 (excision, malignant lesion, face, ears, eyelids, nose, lips; lesion diameter 0.6 to 1.0 cm) for the procedure. Our question is, does this code include the lid repair after removal of the cancerous tissue or may we bill a multi-layer closure?

Anonymous Tennessee Subscriber

Answer: It depends on where the excision took place. If the lesion excision and repair involves the lid margin in any way, then the correct code is either 67961 for an excision and repair that involves less than one-fourth of the lid margin or 67966 if it involves more than one-fourth of the lid margin. These codes include multi-layer closures as well as repairs involving the tarsus, conjunctiva, canthus, full thickness, preparation for a skin graft or pedicle flap with adjacent tissue transfer or rearrangement.

If the malignant lesion excision and repair is located on the eyelid but does not involve the lid margin, the code range 11640-11646 is correct depending on the lesion diameter. You cannot code for simple laceration repair (12011-12018) along with 11641, or any of the other excision codes (11640-11646).

The excision codes include simple sutures, so you cant get paid for the simple laceration repair codes. However, intermediate or complex repair is not bundled with the excision codes. Therefore, you could bill 12051-12057 for intermediate repairs, or 13150-13152 for complex repairs.

Contributors to answers: Susan Callaway-Stradley, CPC, CSS-P, an independent coding consultant and educator in North Augusta, SC; Barbara Cobuzzi, CPC, president of Cash Flow Solutions in Lakewood, NJ; Heather Freeland, consultant at Rose and Associates in Duncanville, TX; Roxanne Oyler, CPC, business supervisor at Kentucky Eye Care in Louisville, KY; Lise Roberts, vice president of Health Care Compliance Strategies in Syosset, NY.