Ophthalmology and Optometry Coding Alert

Ophthalmology Coding Alert recently heard about an ophthalmologist who is billing 67820 (correction of trichiasis; epilation, by forceps only) and 65210 (removal of foreign body, external eye; conjunctival embedded [includes concretions], subconjunctival, or scleral nonperforating) at the same visit. There are circumstances under which such a claim would be valid. But using these two codes for one procedureremoving an ingrown eyelashis not valid. The eyelash is not a foreign body for purposes of 65210.

If you get a superbill with these two procedures, here is what you should ask the physician (or check in the chart for):

1. Were both procedures done in the same eye?
If the answer is that the procedures were performed in different eyes, or different lids of the same eye, you have a valid reason for filing both charges. But make sure you add the eye modifiers (-RT or -LT, or, if you need to be more specific in terms of lids, -E1 for upper left, -E2 for lower left, -E3 for upper right, and -E4 for lower right).

2. If so, in which lid was each procedure performed? If both procedures were performed in the same lid, you are going to need to get further documentation that there was a foreign body independent of the eyelash. For this, you should go to the diagnosis code.

3. What is the diagnosis for each procedure?
For 67820, the diagnosis should be 374.05 (trichiasis). For 65210, the diagnosis should be 930.x (foreign body on external eye).

You can bill the office visit with the -25 modifier if it is documented as a separate and identifiable service from the other procedure or procedures. That means the history, exam and decision-making are documented first, followed by documentation of the procedure or procedures performed.