Question: side may be medically necessary, but the left side would likely be considered cosmetic, how should I code this surgery? Wisconsin Subscriber Answer: In this case, one side will be medically necessary, while the other will be cosmetic -- the procedure will not benefit the vision on the non-seeing eye. Do this: Have the patient sign an advance beneficiary notice (ABN) prior to the surgery, stating that he is aware that Medicare may not cover the entire procedure. Append modifier GA (Waiver of liability statement on file) to the procedure done on the non-seeing eye to indicate that the patient knows he is responsible for the unpaid amount. Example: The patient has congenital ptosis (743.61), and his left eye is non-seeing. The ophthalmologist performs levator resection (67904, Repair of blepharoptosis; [tarso] levator resection or advancement, external approach) bilaterally. Code as follows: • Line 1: 67904-RT linked to 743.61 • Line 2: 67904-LT-GA linked to V50.1 (Elective surgery for purposes other than remedying health states; other plastic surgery for unacceptable cosmetic appearance). If your documentation shows that the procedure was medically necessary on the right side, Medicare will reimburse the full amount for 67904-RT. The cosmetic diagnosis linked to 67904-LT-GA will prompt the carrier to deny the claim, and the explanation of benefits (EOB) will confirm that the patient is responsible for the rest.