Ophthalmology and Optometry Coding Alert

<!--[if gte mso 9]><xml> Normal 0 false false false EN-US X-NONE X-NONE MicrosoftInternetExplorer4 </xml><![endif]--><!--[if gte mso 9]><xml> </xml><![endif]--> 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 modifier 59 (Distinct procedural service) on 15823 to designate a separate site from 67904. Otherwise, you should report only 67904.

The Correct Coding Initiative (CCI) Version 15.1, effective April 1, 2009, 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.

Which code to report as primary depends on the type of facility where you perform the procedure. 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 2010 Physician Fee Schedule assigns more RVUs to 15823 (16.42) than 67904 (15.18). But in a nonfacility, the fee schedule assigns 18.36 RVUs to 67904, but only 17.75 to 15823. So if the oculoplastic surgeon performed the surgery in the office, report 67904 first and 15823-59 second.