Ophthalmology and Optometry Coding Alert

Question: I'm having trouble with a diagnosis code for a lesion removal. The ophthalmologist says it should be "orbital lipoma," but I can't locate a code for that. I'm also wondering about the procedure code -- the fee ticket said 68540, but I'm wondering if 68110 or 68115 would be more appropriate.

Indiana Subscriber

Answer: Code 67412 (Orbitotomy without bone flap [frontal or transconjunctival approach]; with removal of lesion) is likely to describe the ophthalmologist's work more accurately than 68540 (Excision of lacrimal gland tumor; frontal approach), 68110 (Excision of lesion, conjunctiva; up to 1 cm) or 68115 (... over 1 cm).

Smart idea: Wait for the pathology report on the lesion before deciding on an ICD-9 code for the diagnosis. Once you know what the neoplasm is, assign an appropriate code.

For example, if the lesion is benign, the correct ICD-9 code would be 224.1 (Benign neoplasm of eye; orbit); a primary malignancy would be 190.1 (Malignant neoplasm of eye; orbit); and a carcinoma in situ would be 234.0 (Carcinoma in situ of other and unspecified sites; eye).