Ophthalmology and Optometry Coding Alert

Question: How should we bill removal of a cyst on the upper lid?

Pennsylvania Subscriber

Test your coding knowledge. Determine how you would code this situation before looking at the box below for the answer.



Answer: The answer depends on the nature of the cyst. There are three possibilities:

1. If the cyst is on the lid margin and required reconstructive repair, code either 67961 (excision and repair of eyelid, involving lid margin, tarsus, conjunctiva, canthus, or full thickness, may include preparation for skin graft or pedicle flap with adjacent tissue transfer or rearrangement; up to one-fourth of lid margin) or 67966 (... over one-fourth of lid margin) depending on the amount of the lid margin involved.

2. If the cyst only involves the skin and does not involve the lid margin or other tissues, use the integumentary system codes (11440-11446) depending on the size of the lesion. A repair code could also be indicated if the repair required layered suturing.

3. If the excision involved more than skin tissue, but did not involve the lid margin, 67840* (excision of lesion of eyelid [except chalazion] without closure or with simple direct closure) is the correct code.