A 65-year-old male with severe droopy upper eyelids that also have severe spider veins along with skin plaques presents to the ambulatory surgery center for a non-cosmetic blepharoplasty of his upper eyelids. The diagnosis was pseudoptosis causing visual impairment along with a severe case of acne rosacea. Select the appropriate CPT and ICD-10-CM codes.

Question

Quizplus · Accepted Answer

The correct CPT code for a non-cosmetic blepharoplasty of the upper eyelids is 15823, and the modifier -50 is used for procedures performed on both sides (bilateral). The ICD-10-CM codes H02.31 and H02.34 correspond to pseudoptosis and drooping of the upper eyelids, respectively. H53.453 is not a valid code in this context, making option B the correct choice with the correct diagnosis codes for pseudoptosis, drooping of the upper eyelids, and L71.8 for acne rosacea.

A 65-Year-Old Male with Severe Droopy Upper Eyelids That Also