How To Use CPT Code 15823

CPT 15823 refers to a surgical procedure for trimming excessive skin that weighs down the upper eyelid, typically performed for cosmetic improvement and vision interference. This article will cover the description, procedure, qualifying circumstances, billing guidelines, documentation requirements, historical information, similar codes, and examples of CPT 15823.

1. What is CPT 15823?

CPT 15823 is a medical procedure code used to describe the surgical removal of excessive skin from the upper eyelid that weighs it down. This procedure is typically performed to improve the cosmetic appearance of the face and to address the interference of the excessive tissue in the patient’s vision.

2. 15823 CPT code description

The official description of CPT code 15823 is: “Blepharoplasty, upper eyelid; with excessive skin weighting down lid.”

3. Procedure

The 15823 procedure involves the following steps:

  1. The patient is appropriately prepped and anesthetized.
  2. The provider makes an incision along the upper rim of the eyelid.
  3. The skin is pulled taut, and the excessive skin weighing down the eyelid is excised or trimmed.
  4. If necessary, the muscle fascia is sutured to provide additional support to a sagging muscle.
  5. The wound is closed in layers with sutures.

4. Qualifying circumstances

Patients eligible to receive CPT code 15823 services are those who have excessive skin on their upper eyelids that interferes with their vision or causes cosmetic concerns. Medical necessity must be established, and the patient’s medical history, physical examination, and any relevant diagnostic tests should be documented. The provider should also consider the patient’s overall health and any potential risks or complications associated with the procedure.

5. When to use CPT code 15823

It is appropriate to bill the 15823 CPT code when the provider surgically trims excessive skin from the upper eyelid that weighs it down, causing vision interference or cosmetic concerns. The procedure should be medically necessary, and the patient’s medical history, physical examination, and any relevant diagnostic tests should be documented.

6. Documentation requirements

To support a claim for CPT 15823, the following information should be documented:

  • Patient’s medical history and physical examination
  • Relevant diagnostic tests, such as visual field testing or photography
  • Medical necessity for the procedure
  • Details of the procedure, including the incision, excision, and closure
  • Postoperative care instructions and follow-up appointments

7. Billing guidelines

When billing for CPT code 15823, medical coders and billers should ensure that the procedure is medically necessary and supported by the patient’s medical history, physical examination, and any relevant diagnostic tests. If the procedure is performed bilaterally, modifier 50 should be added to the code. Additionally, coders should be aware of any payer-specific guidelines or requirements related to billing for this procedure.

8. Historical information

CPT 15823 was added to the Current Procedural Terminology system on January 1, 1990. There have been no updates to the code since its addition.

9. Similar codes to CPT 15823

Five similar codes to CPT 15823 and how they differentiate are:

  1. CPT 15820: This code is for lower eyelid blepharoplasty without excessive skin.
  2. CPT 15821: This code is for lower eyelid blepharoplasty with excessive skin.
  3. CPT 15822: This code is for upper eyelid blepharoplasty without excessive skin.
  4. CPT 67901: This code is for the repair of ectropion, which is a condition where the eyelid turns outward.
  5. CPT 67902: This code is for the repair of entropion, which is a condition where the eyelid turns inward.

10. Examples

Here are 10 detailed examples of CPT code 15823 procedures:

  1. A 55-year-old patient with excessive upper eyelid skin causing vision interference undergoes blepharoplasty.
  2. A 60-year-old patient with a history of chronic headaches due to the weight of excessive upper eyelid skin undergoes blepharoplasty.
  3. A 45-year-old patient with significant upper eyelid skin redundancy causing cosmetic concerns undergoes blepharoplasty.
  4. A 50-year-old patient with excessive upper eyelid skin that interferes with the use of contact lenses undergoes blepharoplasty.
  5. A 65-year-old patient with excessive upper eyelid skin causing difficulty in reading undergoes blepharoplasty.
  6. A 70-year-old patient with excessive upper eyelid skin that results in a block in the visual axis undergoes blepharoplasty.
  7. A 52-year-old patient with excessive upper eyelid skin causing pressure on the eyelashes undergoes blepharoplasty.
  8. A 48-year-old patient with excessive upper eyelid skin that affects peripheral vision undergoes blepharoplasty.
  9. A 57-year-old patient with excessive upper eyelid skin causing constant eye irritation undergoes blepharoplasty.
  10. A 62-year-old patient with excessive upper eyelid skin that interferes with daily activities, such as driving, undergoes blepharoplasty.

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