Blepharoplasty - MCS a
Blepharoplasty - MCS a
Blepharoplasty - MCS a
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Clinical Medical Policy Department<br />
Clinical Affairs Division<br />
374.02 Mechanical entropion<br />
374.03 Spastic entropion<br />
374.04 Cicatricial entropion<br />
374.05 Trichiasis without entropion<br />
374.10 Ectropion, unspecified<br />
374.11 Senile ectropion<br />
374.12 Mechanical ectropion<br />
374.13 Spastic ectropion<br />
374.14 Cicatricial ectropion<br />
374.20 Unspecifice lagophthalmos<br />
374.21 Paralytic lagophthalmos<br />
374.22 Mechanical lagophthalmos<br />
374.23 Cicatricial lagophthalmos<br />
374.30 Unspecified ptosis of eyelid<br />
374.31 Paralytic ptosis<br />
374.32 Myogenic ptosis<br />
374.33 Mechanical ptosis<br />
374.34 Blepharochalasis<br />
374.41 Eyelid retraction or lag<br />
374.82 Edema of eyelid<br />
374.87 Dermatochalasis<br />
376.21 Thyrotoxic exophthalmos<br />
743.00 Clinical anophthalmos, unspecified<br />
743.61 Congenital ptosis<br />
743.62 Congenital deformity of eyelid<br />
743.63 Other specified congenital anomalies of eyelid<br />
996.69 Infection and inflammatory reaction due to other internal prosthetic device, implant,<br />
and graft<br />
V45.78 Acquired absence of organ, eye<br />
*2013 ICD-9-CM®For Physicians, VOLUMES I & II, Professional Edition (American Medical Association).<br />
ICD-10 Codes (Preview Draft)<br />
In preparation for changes in the coding systems form ICD- 9 to ICD -10, this policy includes a sample list<br />
of ICD-10 codes for your reference. These codes may become subject to changes or modifications since<br />
they will be in effect on October 1, 2014.<br />
ICD-10-Codes<br />
G51.0 Bell's palsy<br />
H44.40 Unspecified hypotony of eye<br />
DESCRIPTION<br />
H53.451 Other localized visual field defect, right eye<br />
H53.452 Other localized visual field defect, left eye<br />
H53.453 Other localized visual field defect, bilateral<br />
This document is designated for informational purposes only and is not an authorization, or an explanation of benefits (EOB), or a contract.<br />
Medical technology is constantly changing and we reserves the right to review and update our policies periodically.<br />
Medical Card System, Inc.<br />
All Rights Reserved®<br />
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