Tip: Look beyond ICD-9's eye section -- there are more options than you think
Your individual carriers may have their own local coverage determinations (LCDs) instructing you which diagnoses support medical necessity for blepharoplasty procedures 15822 (Blepharoplasty, upper eyelid) or 15823 (- with excessive skin weighting down lid). But if your ophthalmologist has documented one of the following ICD-9 codes that carriers often consider medically necessary, you-re well on your way to showing carriers that the surgery was for more than cosmetic reasons.
- 373.4 -- Infective dermatitis of eyelid of types resulting in deformity
- 373.5 -- Other infective dermatitis of eyelid
- 373.6 -- Parasitic infestation of eyelid
- 374.30 -- Ptosis of eyelid, unspecified
- 374.31 -- Paralytic ptosis
- 374.32 -- Myogenic ptosis
- 374.33 -- Mechanical ptosis
- 374.34 -- Blepharochalasis
- 374.87 -- Dermatochalasis
- 374.89 -- Other disorders of eyelid
- 743.61 -- Congenital ptosis
- 743.62 -- Congenital deformities of eyelid
- 743.63 -- Other specified congenital deformities of eyelid
- V52.2 -- Fitting and adjustment of artificial eye.