Medicare Compliance & Reimbursement - 2018 Issue 2
Reader Question: Cosmetic Blepharoplasty Or Not? Find Out
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Article Overview
This short coding Q&A discusses the kinds of ICD-10-CM diagnoses payers may review when blepharoplasty is being justified as medically necessary instead of cosmetic. It is aimed at coders and billing staff who need a broad understanding of payer documentation expectations and the general categories of diagnoses referenced in this context.
Why This Topic Matters
Blepharoplasty claims can be scrutinized closely, and the supporting diagnosis documentation may affect whether the procedure is treated as cosmetic or medically necessary. The article helps readers understand the relevance of diagnosis coding and payer review without replacing payer-specific policy review.
What You Will Learn
- How payer guidelines can affect documentation review for blepharoplasty.
- Why diagnosis documentation matters in distinguishing cosmetic from medically necessary procedures.
- The general kinds of ICD-10-CM diagnoses referenced in payer discussions of blepharoplasty.
- How Medicare is referenced in the context of cosmetic procedure coverage.
Who Should Read This
- Medical coders
- Billing staff
- Revenue cycle staff
- Ophthalmology practices
- Oculoplastic surgery practices
Codes Discussed
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