Ophthalmology and Optometry Coding Alert

Per eye, per lash, or per lid? Know the right way to code.

An eyelash growing in toward a patient’s eye may seem like a small issue to a coder, but to the patient it can be immeasurably irritating and even painful. However, your coding process for fixing these issues doesn’t have to be irritating or painful, as long as you know the right way to report these services.

The first step is to determine which CPT^® code is the most accurate. Whereas 67820 (Correction of trichiasis; epilation, by forceps only) involves performing the procedure via forceps, you can use 67825 (...  epilation by other than forceps [e.g., by electrosurgery, cryotherapy, laser surgery]) for procedures involving other methods. But how to report these codes if the patient has more than one troubling eyelash can be difficult to determine.

Take a look at the following three coding options — it’s up to you, the reader, to determine which two options are myths and which is the right way to code the service.

Possibility 1: Code Per Eye

To report this service, 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 on both eyes.

For example, your optometrist, by use of forceps, removes one lash from a patient’s left lower eyelid and two lashes from the same patient’s right upper eyelid. You should code 67820-50 if the carrier is Medicare, and 67820-LT, 67820-50-RT for private carriers who prefer that you bill this way.

Possibility 2: Code Per Eyelid

You’ll report the appropriate epilation code along with a modifier that denotes which eyelid(s) you addressed. The eyelid modifiers you should use are E1 (Upper left, eyelid), E2 (Lower left, eyelid), E3 (Upper right, eyelid) and E4 (Lower right, eyelid).

For example, a patient presents with trichiasis of two lashes of her upper left eyelid, one lash of her lower left eyelid, and one lash of her lower right eyelid. The severity of the irritation to the patient’s eyes constitutes medical necessity for removing the lashes via electrosurgery. The doctor performs epilation of all the lashes. The procedures should be coded 67825-E1, 67825-51-E2, 67825-51-E4.

Possibility 3: Code Per Eyelash

Instead of counting the eyes or eyelids involved, you should instead report the code based on how many eyelashes you remove. In this scenario, you’ll change the number of units you should bill depending on how many eyelashes the doctor removes.

For example, the doctor removes four lashes from the patient’s left upper eyelid and three lashes from the patient’s right lower eyelid using forceps. You’ll report seven units of 67820 on your claim.

Figured Out Which You’d Code? Now Check the Solution

Now that you’ve selected a coding option for epilation, it’s time to check out the way most payers want you to bill, and that’s with possibility number one above: coding per eye.

“When the above codes are submitted on a claim, report the codes per eye; not per eyelash or per eyelid,” says Palmetto GBA in its trichiasis policy. “When performed unilaterally, the quantity-billed field (days/units) must be ‘one,’” the policy says.

If you instead report the procedure bilaterally, report one unit of the appropriate code with modifier 50 appended, Palmetto advises. Other payers such as private carriers, however, may ask you to use modifiers LT or RT instead.