The Ophthalmic Office Procedures Handbook

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SECTION 3 Lids, Lashes, and Adnexa

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CODING/BILLING CPT code: 67840 —In this procedure, the clinician excises a diseased or damaged area from the eyelid, excluding a chalazion. If necessary, they close the wound with sutures. (Le sion may or may not be sent to pathology for identification). Used for Excisional biopsy which may include punch biopsy if the goal is to remove the entire lesion. If not sent to the pathologist, this is the code to use for all non-lid margin lesions including lash line lesions. CPT code: 67810 —The clinician takes a sample of suspicious area on the skin of the eyelid or its edges. The specimen is submitted to a laboratory for analysis to determine its nature. Used for incisional biopsy: shave or punch . This can be used for shave biopsy of the lid margin if the specimen is sent to pathology for identification. This can be for lid margin, lash line, and periocular lesions. CPT code: 67850 —The clinician destroys a small lesion of the lid margin , no larger than 1 cm, on the area between the front lid edge and back edge of any of the four lids of the eye. From the definition, this code does not appear to include specimens that need to be sent to pathology. Office exam: CPT per level of examination —Some insurance carriers will not pay for both the office visit and lesion removal on the same day unless there are other ocular disease or conditions listed and addressed; for example, cataracts, dermatochalasis, and refractive error. Photography: 92285— External ocular photography documents the medical progress of the external eye and ocular adnexa. Photographs record conditions and pathology of the ad nexa, external eye, and anterior segment more accurately than charting notes or drawings. They are used to track changes in patient’s abnormal conditions over time. Common ICD-10 codes that support these procedures include the following: ● D23.1 (benign neoplasm of eyelid) —This can be further delineated by D23.111 right upper lid, D23.112 right lower lid, D23.121 left upper lid, and D23.122 left lower lid. ● D49.2 (neoplasm of unspecified behavior of the skin) . ● C44.10 (malignant neoplasm of the eyelid)— This can also be delineated for which par ticular lid has the lesion, C44.1021 right upper lid, C44.1022 right lower lid, C44.1091 left upper lid, and C44.1092 left lower lid.