niurkasilva@yahoo.com
Contributor
Hi coders I need some help. 15823 and 67904 can be billed together, do I need a modifier 59? Thank You.
Last edited:
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Wiki 15823 with 67904
- Thread starter niurkasilva@yahoo.com
- Start date
salCCS
Networker
usually only report 67904 but there are times you can report both here is a link to help you determine if your case falls under this situation.
http://codingnews.inhealthcare.com/...ery-coding-challenge-denials-for-15823-67904/
this is very helpful.
Sal
http://codingnews.inhealthcare.com/...ery-coding-challenge-denials-for-15823-67904/
this is very helpful.
Sal
niurkasilva@yahoo.com
Contributor
Thank you so much for your help.
salCCS
Networker
Anytime
laker
New
I disagree, you should be able to bill both as long as both are documented. See below from August 2011 issue of CPT assistant.
"THEN
The CPT Assistant Newsletter (September 2000; p 7) cited the following regarding the reporting of blepharoplasty and blepharoptosis:
The fundamental difference between the blepharoplasty and the blepharoptosis repair is that a blepharoplasty is surgery on the skin of the upper eyelid and the orbital fat, while a blepharoptosis repair is surgery on the levator muscle of the eyelid. These procedures may either be done independently or together on the same eye depending upon the surgical indication. This would occur when the upper eyelid has redundant skin and the levator muscle is unable to elevate the eyelid to the normal position. When these two procedures are done on the same upper eyelid, both procedural codes are needed to accurately describe the procedure. The coder should include the multiple procedures Modifier 51 with the second code.
NOW
The instruction reported in the September 2000 issue of the CPT Assistant Newsletter remains correct, ie, it is still appropriate to report code 15823, Blepharoplasty, upper eyelid; with excessive skin weighting down lid, in addition to code 67904, Repair of blepharoptosis; (tarso) levator resection or advancement, external approach, when both procedures are performed on the same eyelid. It is also appropriate to append modifier 51, Multiple Procedures, to the second code.
Third-party payer guidelines may, however, differ from CPT coding guidelines, as both coverage and payment policy is determined by individual insurers and third-party payers. For reimbursement or third-party payer policy issues, please contact the applicable payer. "
Lorrae Aker, CPC
"THEN
The CPT Assistant Newsletter (September 2000; p 7) cited the following regarding the reporting of blepharoplasty and blepharoptosis:
The fundamental difference between the blepharoplasty and the blepharoptosis repair is that a blepharoplasty is surgery on the skin of the upper eyelid and the orbital fat, while a blepharoptosis repair is surgery on the levator muscle of the eyelid. These procedures may either be done independently or together on the same eye depending upon the surgical indication. This would occur when the upper eyelid has redundant skin and the levator muscle is unable to elevate the eyelid to the normal position. When these two procedures are done on the same upper eyelid, both procedural codes are needed to accurately describe the procedure. The coder should include the multiple procedures Modifier 51 with the second code.
NOW
The instruction reported in the September 2000 issue of the CPT Assistant Newsletter remains correct, ie, it is still appropriate to report code 15823, Blepharoplasty, upper eyelid; with excessive skin weighting down lid, in addition to code 67904, Repair of blepharoptosis; (tarso) levator resection or advancement, external approach, when both procedures are performed on the same eyelid. It is also appropriate to append modifier 51, Multiple Procedures, to the second code.
Third-party payer guidelines may, however, differ from CPT coding guidelines, as both coverage and payment policy is determined by individual insurers and third-party payers. For reimbursement or third-party payer policy issues, please contact the applicable payer. "
Lorrae Aker, CPC
mitchellde
True Blue
The CPT assistant is from 2000 the CCI update is from 2009, this means there has been a change in logic so if performed on the same eyelid, only one is reported.
mzkandyd
Guest
I agree with Debra. You can only code the 67904 as the Bleph bundles in. If you need the supporting documentation please email me directly and I can provide it.