Ophthalmology and Optometry Coding Alert

Question: A patient presented with an open wound that our physician prepped and sutured shut. The patient had had a blepharoplasty performed by another physician just a few days prior to the wound opening. How should we bill for this?

Oregon Subscriber

Answer: Part of the coding confusion comes from the 90-day global period attached to the blepharoplasty, 15820-15823 depending on the exact location on the eyelid and the conditions of the procedure.

The confusion is compounded because your physician did not perform the procedure. And you are probably asking yourself if the wound is even considered related to the blepharoplasty at all.

This is a case where the dehiscence of the wound that requires a repair procedure is not included in the original blepharoplasty, since it was not the surgeon who did the blepharoplasty that required the dehiscence. If it had been and it was done in the office, it would have been included.

To indicate the dehiscence of the operation wound, first apply an ICD-9 code of 998.3 (Other complications of procedures, not elsewhere classified; disruption of operation wound). Next code the skin wound repair (12011-12018 for simple repair, 12051-12057 for intermediate, and 13150-13153 for complex). A modifier such -78 or -79 is not required because your physician is not the original surgeon.

Answers to You Be the Coder and Reader Questions contributed by Lise Roberts, vice president, Health Care Compliance Strategies, Jericho, N.Y.; and Raequell Duran, president, Practice Solutions, Santa Barbara, Calif.