tci Outpatient Facility Coding Alert - 2017 Issue 4

Reader Question: Look for Evidence of Surgical Approach Changes

Question: Our ophthalmologist performed a blepharoptosis repair using the frontalis muscle technique. He started with the external approach, but his visualization was limited using that approach, so he then changed his technique and used an internal approach instead. We reported both 67903 and 67904 and appended modifier 59 to 67904, but the insurer denied the charge for 67904. According to the CCI edits, we should be able to collect for 67904 if we append modifier 59. Should we appeal? Supercoder.com Subscriber Answer: No, you should not appeal. Typically, you would only report 67903 (Repair of blepharoptosis; [tarso] levator...

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