Area of Coding Confusion: The Eyes Have It!

Vol. 12 •Issue 1 • Page 7
Area of Coding Confusion: The Eyes Have It!

(Editor’s note: ADVANCE is excited to debut a new coding column for 2002. Coding Outlook, designed to answer some tough coding questions, will be featured seven times throughout the year, so be on the look out for this new column in March, April, June, August, October and December.)

One of the anatomical areas causing coding confusion is the eye. We’ll cover eyelid surgery first.

The first decision for coding eyelid surgery is the reason for the surgery. If the physician does not state the reason–cosmetic or reconstructive–consider the following guideline:

•Cosmetic surgery involves changing an unsatisfactory physical appearance where there are no indications of functional abnormalities, and is performed on normal structures. Of note, third-party payers do not generally reimburse cosmetic surgeries.

•Reconstructive surgery aims to correct functional problems including ptosis, congenital defects and defects due to trauma and/or surgery. Reconstructive surgery may also be performed to create a normal appearance. Third-party payers normally cover these procedures.

Many blepharoplasties are performed for the correction of ptosis, a condition in which the eyelid droops more than normal. Ptosis can affect one or both eyes and can be severe enough to physically impair vision. Ptosis can also be defined as a true ptosis, which is a lack of eyelid support, or a pseudoptosis, also called dermatochalasis, indicating excess lid tissue. Ptosis may be congenital or acquired.

When the cause of the ptosis is a matter of excess tissue, it is treated by a reconstructive upper lid surgery that removes excess skin. These procedures are located in the CPT category under skin surgeries. If the surgeon must also adjust the muscles underlying the skin, CPT directs the coder to the surgical category “Eye and Ocular Adnexa.”

When the forehead and brow area also droop, causing additional weight on the eyelid area, the above eyelid surgery may not be sufficient to correct the condition; a brow or forehead (scalp) lift may be required to fully correct the ptosis. The extent of the surgery will determine the correct CPT code: 15824 for a rhytidectomy; 67900 for brow ptosis. Remember rhytid means wrinkles–this will direct you to the correct system.

If the surgeon must operate on the underlying muscles of the eyelid to create the repair, knowledge of the facial musculature is essential. The frontalis muscle (CPT codes 67901 and 67902) is the muscle of the forehead. The tarsal muscles, both inferior and superior and the levator muscle (present only in the upper lid) are the small muscles that allow the lids to open and close. These procedures are coded with CPT codes 67903 and 67904; an internal approach is made through the conjunctiva; external is through the skin of the eyelid. The Muller’s muscle referenced in CPT code 67908 is a muscle located only in the upper lid between the aponeurosis and levator muscles; this procedure is more extensive than the previous surgeries noted.

Other conditions that may require surgical correction are birth defects, post traumatic (acquired) abnormalities and lash margin deformities.

Remember when coding unilateral reconstruction, surgery may be performed on the other eyelid to produce a symmetrical appearance. This additional procedure should be considered a reconstructive surgery.

Eye surgeries are not simple to code. Experience, attention to detail and your knowledge of anatomy can make it easier! n

Sandra Evans is a senior consultant with HP3, having more than five years’ coding experience. She can be reached at info@

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