Ophthalmology and Optometry Coding Alert

" Confusion about coding epilation for trichiasis can be a thing of the past if you can keep up with your modifiers. Epilation for trichiasis 67820* (Correction of trichiasis; epilation, by forceps only) and CPT 67825* ( epilation by other than forceps [e.g., by electrosurgery, cryotherapy, laser surgery]) the removal of uncomfortable misdirected eyelashes that grow in toward the eyeball, can be a difficult procedure to code because different carriers demand different methods of billing. Coding epilation becomes even more daunting if your physician completes the procedure bilaterally or on multiple eyelids, or if more than one eyelash is removed. How can coders keep epilation billing straight and ensure proper reimbursement? The first step to correct coding is to determine your payer's accepted billing method. There are three methods of billing epilation per eye, per eyelid, and per lash and your payer will only reimburse you for claims submitted by one of these methods.

Typically, private payers consider billing per eye to be the correct way to handle epilation coding. In contrast, some Medicare carriers, such as Noridian Mutual of Arizona, pay by the eyelid. And on a rare occasion, you may come across a carrier with an LMRP that allows for billing for each lash. I always recommend that you check with your local payer representative and ask for their filing guidelines on this procedure" " says Sherry Searson CPC an independent coding consultant based in Charleston S.C. "This will reduce your denials and save time and money on refiling denied claims."

Regardless of the method you must use to garner reimbursement for epilation you must document an ICD-9 code that signals to Medicare that the procedure was performed out of medical necessity. Acceptable diagnosis codes will vary among carriers but some ICD-9 codes that typically support medical necessity include 374.01 Senile entropion; 374.04 Cicatricial entropion; 374.05 Trichiasis without entropion; 374.54 Hypertrichosis of eyelid; and 374.89 Other disorders of eyelid. Method 1: Code Per Eye If the carrier pays per eye you should use the correct epilation code 67820 or 67825 with the correct eye modifier -RT or -LT or modifier -50 (Bilateral procedure) if performed bilaterally.

Procedure codes 67820 and 67825 are designated bilateral indicator "0" codes by the 2002 National Physician Fee Schedule. The "0" indicates that bilateral rules do not apply (to 67820 and 67825) because of physiology or anatomy or because the code description specifically states that it is a unilateral code. Therefore bilateral modifier -50 is not a viable option for indicating epilation of lashes on both eyes. However epilation codes 67820 and 67825 have a multiple-procedure indicator of "2" that indicates standard payment [...]