Ophthalmology and Optometry Coding Alert

Question: Can CPT® codes 15823 and 67904 be billed together? Would I need a modifier?

Florida Subscriber

Answer: CPT® codes 15823 (Blepharoplasty, upper eyelid, with excessive skin weighing down lid) and 67904 (Repair of blepharoptosis; [tarso] levator resection or advancement, external approach) are bundled together by the Correct Coding Initiative (CCI) as mutually exclusive procedures, meaning that a practitioner would not normally be able to perform both procedures on the same site during the same session. 

However, the bundle is marked with modifier indicator “1,” meaning that you can report the two codes together given the right clinical circumstances. If, for example, the procedures were performed on different eyes, you would be justified in expecting reimbursement for both procedures.

Example: If the ophthalmologist performs the blepharoplasty (bleph) with excessive weight (15823) on one eye and the blepharoptosis (ptosis) repair (67904) 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. You would also append modifiers LT (Left side) and RT (Right side) as appropriate to each code.

Otherwise, you should report only 67904, the more extensive procedure.