PHIC PHILHEALTH CIRCULAR NO. 06, S. 2004, February 12, 2004

[ PHIC PHILHEALTH CIRCULAR NO. 06, S. 2004, February 12, 2004 ]

INCLUSION OF BLEPHAROPLASTY AND PTOSIS SURGERY IN RELATIVE VALUE SCALE 2001

Pursuant to PhilHealth Board Resolution No. 627, s. of 2003, blepharoplasty and ptosis surgery shall be included in RVS 2001 list of compensable procedures provided that they are performed to correct functional or visual impairment due to dermatochalasis, blepharochalasis, blepharoptosis, and pseudoptosis and NOT for cosmetic reasons.

Claims for blepharoplasty/ptosis surgery performed for other causes of functional or visual impairment may also be reimbursed after due evaluation by the Peer Review Committee.

The following are the codes, descriptive terminologies and RVU assigned for these procedures:

CODE DESCRIPTIVE TERMS

RVU

15820 Blepharoplasty, lower eyelid 45

15822 Blepharoplasty, upper eyelid; 45

15823 With excessive skin weighting down lid 60

67900 Repair of brow ptosis (supraciliary, midforehead or coronal approach) 95

67901 Repair of blepharoptosis; frontalis muscle technique with suture or other material 100

67902 Frontalis muscle technique with fascial sling (includes obtaining fascia) 120

67903 (tarso) levator resection or advancement, internal approach 100

67904 (tarso) levator resection or advancement, external approach 100

67906 Superior rectus technique with fascial sling (includes obtaining fascia) 100

67908 Conjunctivo-tarso-Muller's muscle-levator resection (Fasanella-Servat type 75

In order to establish the compensability of blepharoplasty and ptosis surgeries, all claims for these procedures must be submitted together with a fully accomplished PhilHealth Claim Form 3 or a copy of Clinical Abstract. The surgeon should document the indication for the surgery through history and physical examination findings. Operating room records should also support the presence of the indications. Claims with incomplete requirements shall not be processed and shall be returned to hospital for completion.

All other Circulars consistent herewith remain in full force and effect.

This circular will take effect 15 days following publication hereof.

Please be guided accordingly.

Adopted: 12 Feb. 2004

(SGD.) FRANCISCO T. DUQUE, MD, MSc President and CEO