Wiki Help on Eyelid biopsy

[jelms]

Hello, I am a new coder in ophthalmology and have been presented with a case of excisional biopsy eyelid lesions to code. I was wondering if someone here would be able to help me code this operative report as I do not have much experience in biopsy

Path Report Shows:
A: FS, Right Upper Lid pigmented lesions x2 = Lentigo/Hyperpigmentation
B: Additional Right Upper Lid= Post inflammatory hyperpigmentation
C: Pigmented Left Upper Lid= Lentigo w/ atypical melanocytic hyperplasia

Surgical Report:
PROCEDURE: He was taken to the operating room and
positioned in the supine position. A drop of tetracaine
was applied to each eye and he was prepped and draped in
the usual fashion. Metallic corneal shields with
Celluvisc were inserted bilaterally. Throughout the
procedure, he received a total of 1 mL of 2% lidocaine
with 1:100,000 epinephrine into the upper eyelids.
Westcott scissors were used to obtain biopsy specimens
from the right side. This was sent for the frozen section
and came back as listed above. The pigment was very
superficial and the rest of the pigmented area was
debrided with a #15 Bard-Parker blade. The left upper
eyelid pigmented area was excised and sent in separate
formalin container for permanent section. Additional
specimen from the right upper eyelid edge was also sent
directly for permanent section. Bipolar cautery was used
for hemostasis. Erythromycin ung was applied but no
bandages. Instructions were given. He tolerated the
procedure well and left the operating room in good
condition.


Thanks..

 

[grth97]

67810
Biopsy of eyelid

Coding Tips

This is a unilateral procedure. If performed bilaterally, some payers require that the service be reported twice with modifier 50 appended to the second code while others require identification of the service only once with modifier 50 appended. Check with individual payers. Modifier 50 identifies a procedure performed identically on the opposite side of the body (mirror image). When 67810 is performed with another separately identifiable procedure, the highest dollar value code is listed as the primary procedure and subsequent procedures are appended with modifier 51. If multiple areas are biopsied, report 67810 for each site taken and append modifier 59 Distinct procedural service, to additional codes. Surgical trays, A4550, are not separately reimbursed by Medicare; however, other third-party payers may cover them. Check with the specific payer to determine coverage.