Ophthalmology and Optometry Coding Alert
Prove Medical Necessity for Blepharoplasty
Florida Subscriber
Answer: Coding for blepharoplasty (15823, Blepharoplasty, upper eyelid; with excessive skin weighting down lid) and a levator repair (67904, Repair of blepharoptosis; [tarso] levator resection or advancement, external approach) can be tricky.
Since the child's vision is affected, carriers will consider this procedure medically necessary.
A blepharoplasty, an excision of skin and fat, and levator repair, an excision of muscle, can sometimes confuse coders when both procedures are done at the same time. The National Correct Coding Initiative considers codes 15823 and 67904 bundled.
In your example, the patient is a 4-year-old and should be covered by the parent's insurance. You should definitely report both procedures and send a paper claim with a copy of the operative report.
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