Notification



Notification Issue Date:



Policy Attachment



Attachment to Policy # 11.05.02i


Attachment:A

Policy #:11.05.02i

Description:ICD-10 Codes

Title:Blepharoplasty, Repair of Blepharoptosis, Repair of Brow Ptosis, and Canthoplasty/Canthopexy


Inclusion of a code in this table does not imply reimbursement. Eligibility, benefits, limitations, exclusions, precertification/referral requirements, provider contracts, and Company policies apply.

The codes listed below are updated on a regular basis, in accordance with nationally accepted coding guidelines. Therefore, this policy applies to any and all future applicable coding changes, revisions, or updates.

In order to ensure optimal reimbursement, all health care services, devices, and pharmaceuticals should be reported using the billing codes and modifiers that most accurately represent the services rendered, unless otherwise directed by the Company.



H02.011 Cicatricial entropion of right upper eyelid

H02.012 Cicatricial entropion of right lower eyelid

H02.014 Cicatricial entropion of left upper eyelid

H02.015 Cicatricial entropion of left lower eyelid

H02.021 Mechanical entropion of right upper eyelid

H02.022 Mechanical entropion of right lower eyelid

H02.024 Mechanical entropion of left upper eyelid

H02.025 Mechanical entropion of left lower eyelid

H02.031 Senile entropion of right upper eyelid

H02.032 Senile entropion of right lower eyelid

H02.034 Senile entropion of left upper eyelid

H02.035 Senile entropion of left lower eyelid

H02.041 Spastic entropion of right upper eyelid

H02.042 Spastic entropion of right lower eyelid

H02.044 Spastic entropion of left upper eyelid

H02.045 Spastic entropion of left lower eyelid

H02.111 Cicatricial ectropion of right upper eyelid

H02.112 Cicatricial ectropion of right lower eyelid

H02.114 Cicatricial ectropion of left upper eyelid

H02.115 Cicatricial ectropion of left lower eyelid

H02.121 Mechanical ectropion of right upper eyelid

H02.122 Mechanical ectropion of right lower eyelid

H02.124 Mechanical ectropion of left upper eyelid

H02.125 Mechanical ectropion of left lower eyelid

H02.131 Senile ectropion of right upper eyelid

H02.132 Senile ectropion of right lower eyelid

H02.134 Senile ectropion of left upper eyelid

H02.135 Senile ectropion of left lower eyelid

H02.141 Spastic ectropion of right upper eyelid

H02.142 Spastic ectropion of right lower eyelid

H02.144 Spastic ectropion of left upper eyelid

H02.145 Spastic ectropion of left lower eyelid

H02.151 Paralytic ectropion of right upper eyelid

H02.152 Paralytic ectropion of right lower eyelid

H02.153 Paralytic ectropion of right eye, unspecified eyelid

H02.154 Paralytic ectropion of left upper eyelid

H02.155 Paralytic ectropion of left lower eyelid

H02.156 Paralytic ectropion of left eye, unspecified eyelid

H02.159 Paralytic ectropion of unspecified eye, unspecified eyelid

H02.31 Blepharochalasis right upper eyelid

H02.32 Blepharochalasis right lower eyelid

H02.34 Blepharochalasis left upper eyelid

H02.35 Blepharochalasis left lower eyelid

H02.411 Mechanical ptosis of right eyelid

H02.412 Mechanical ptosis of left eyelid

H02.413 Mechanical ptosis of bilateral eyelids

H02.421 Myogenic ptosis of right eyelid

H02.422 Myogenic ptosis of left eyelid

H02.423 Myogenic ptosis of bilateral eyelids

H02.431 Paralytic ptosis of right eyelid

H02.432 Paralytic ptosis of left eyelid

H02.433 Paralytic ptosis of bilateral eyelids

H02.831 Dermatochalasis of right upper eyelid

H02.832 Dermatochalasis of right lower eyelid

H02.834 Dermatochalasis of left upper eyelid

H02.835 Dermatochalasis of left lower eyelid

H02.842 Edema of right lower eyelid

H02.845 Edema of left lower eyelid

H04.551 Acquired stenosis of right nasolacrimal duct

H04.552 Acquired stenosis of left nasolacrimal duct

H04.553 Acquired stenosis of bilateral nasolacrimal duct

H04.559 Acquired stenosis of unspecified nasolacrimal duct

H49.00 Third [oculomotor] nerve palsy, unspecified eye

H49.01 Third [oculomotor] nerve palsy, right eye

H49.02 Third [oculomotor] nerve palsy, left eye

H49.03 Third [oculomotor] nerve palsy, bilateral

H49.40 Progressive external ophthalmoplegia, unspecified eye

H49.41 Progressive external ophthalmoplegia, right eye

H49.42 Progressive external ophthalmoplegia, left eye

H49.43 Progressive external ophthalmoplegia, bilateral

L91.9 Hypertrophic disorder of the skin, unspecified

Q10.0 Congenital ptosis

Q10.5 Congenital stenosis and stricture of lacrimal duct

Z44.21 Encounter for fitting and adjustment of artificial right eye

Z44.22 Encounter for fitting and adjustment of artificial left eye

Version Effective Date: 10/01/2018
Version Issued Date: 10/01/2018
Version Reissued Date: 12/05/2018



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