Ophthalmology and Optometry Coding Alert

Question: Our ophthalmologist performed a blepharoplasty for a Medicare patient. We told her that  Medicare would deny coverage for the procedure because it considers it cosmetic.
 
Do I still need to file it with Medicare? Do we have to bill the amount that Medicare would allow? Do I need an ABN?
      
New York Subscriber

Answer: You don't need to file the claim to Medicare, and you should charge the patient your standard blepharoplasty fee.
 
If both you and the patient know prior to surgery that the procedure is cosmetic and not covered, you don't need an advance beneficiary notice (ABN).
 
If the patient's other coverage requires that you file and be denied by Medicare, use a V code for the diagnosis, such as cosmetic surgery for the eye, V50.1 (Other plastic surgery for unacceptable cosmetic appearance), and append modifier -GY (Item or service statutorily excluded or does not meet the definition of any Medicare benefit) to the CPT code. 
 
Note: Having the patient complete an ABN never hurts. Make sure the ABN clearly communicates to the patient that Medicare will not cover the service and exactly how much the patient will have to pay.