Ophthalmology and Optometry Coding Alert

Question: How should I report treatments for chalazions?


Pennsylvania Subscriber


Answer: The answer depends on the type of “treatment” the ophthalmologist provided. If the treatment was an injection, such as Kenalog, you should report 11900 (Injection, intralesional; up to and including seven lesions) for intralesional steroid injection of a hemangioma. You would use this code for up to seven intralesional injections of any kind.
 
For eight or more lesions, report 11901 (… more than seven lesions).

Remember: Your carrier may also want you to append an eyelid modifier to specify the location of the injection -- for example, E3 (Upper right, eyelid). Remember to report the steroid supply with the appropriate HCPCS Codes (such as J3301, Injection, triamcinolone acetonide, per 10 mg) as well.

Bonus: If the ophthalmologist performed a significant, separately identifiable E/M service, you can report an E/M code, such as 99212 (Office or other outpatient visit for the evaluation and management of an established patient, which requires at least two of these three key components: a problem-focused history; a problem-focused examination; straightforward medical decision-making) as well as the injection code.

Option two: If the ophthalmologist actually excises the chalazion, you should report a surgical excision code. CPT provides three codes for chalazion excisions in the office: 67800 (Excision of chalazion; single), 67801 (… multiple, same lid) and 67805 (… multiple, different lids).