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lower lid blepharoplasty with cheek suspension, upper eye lid weight insertion

Eva Posted Fri 04th of October, 2013 17:20:28 PM

Due to facial paralaysis, lowere lid blepharoplasty with cheek suspension and upper eye lid weight insertion was done.
I was looking at 67912 for the weight insertion, but it states to only use it for lagophtalmos, which the patient doesn't have.
Any help is greatly appreciated.

SuperCoder Answered Sat 05th of October, 2013 01:02:07 AM

374.21 is the Dx you can choose for. Please confirm with the physician if this is the case.

Report CPT® code 67912 (Correction of lagophthalmos, with implantation of upper eyelid lid load [e.g., gold weight]) for the insertion of the gold eyelid weights. Ophthalmologists sometimes weigh down a patient's upper eyelids to correct lagophthalmos, which is the inability to close the eye completely. Untreated, the condition could lead to abrasions, infections and corneal drying.

When Medicare developed the new code for this procedure in 2004, the expectation was that reimbursement included the gold weight supply. For non-Medicare payers, you may be able to bill the gold weights with L8610 (Ocular implant) and attach an invoice showing the actual cost by the vendor, to the claim form. However, most payers follow Medicare's policy and include the gold weight supply in the global surgery reimbursement.

Don't miss: When the ophthalmologist implants both lids with gold weights, append modifier 50 (Bilateral procedure) to 67912. Reimbursement should be at 150 percent for both lids. Be sure to include the specific lagophthalmos diagnosis (374.21, Paralytic lagophthalmos) in your claim.

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