Ophthalmology and Optometry Coding Alert

Tip:  If the code definition includes 'upper' or 'lower,' omit E1-E4

Should you always append the eyelid modifiers (E1-E4) when you’re reporting a procedure performed on a specific eyelid? For the answer, check for specific eyelid information in the code descriptor--but don’t lose sight of your carrier’s individual preferences.

Blepharoplasty: Codes 15820-15821 (Blepharoplasty, lower eyelid …) and 15822-15823 (Blepharoplasty, upper eyelid …) all specify an upper or lower eyelid. To specify one particular eyelid, you would just need a “side” modifier (LT, Left side or RT, Right side) in addition to the blepharoplasty code. For example, 15822-LT could only describe blepharoplasty performed on the upper left eyelid.

But some carriers want an eyelid modifier appended to the blepharoplasty code. Part B carrier Palmetto, for example, wants you to report blepharoplasty on the upper left eyelid with 15822-E1. If the ophthalmologist performs blepharoplasty on both upper eyelids, report 15822-50 (Bilateral procedure), Palmetto says.

The descriptions for codes 67901-67908 (Repair of blepharoptosis …) do not specifically mention upper or lower eyelids. However, because blepharoptosis is defined as “drooping of the upper eyelids,” the blepharoptosis repair procedures can only be performed on the upper eyelids. Although most carriers will accept modifiers LT or RT, Palmetto looks for E1-E4 appended to these codes, as well.

Lesion removals: For removal of lesions from the eyelids involving more than the skin, report eyelid lesion removal code 67840 (Excision of lesion of eyelid [except chalazion] without closure or with simple direct closure).

Medicare indicates that this procedure may be reimbursed at 150 percent of the fee schedule amount when performed on both eyes. Report 67840 with modifier 50 (Bilateral procedure) when the ophthalmologist removes lesions bilaterally. Append E1-E4 if required to do so by your payer, says Maggie M. Mac, CMM, CPC, CMSCS, consulting manager for Pershing, Yoakley & Associates in Clearwater, Fla.

Ectropion/entropion: Unlike the blepharoplasty codes, ectropion repair (67914-67917) and entropion repair (67921-67924) do not mention upper or lower lids. As with 67840, Medicare will reimburse bilateral ectropion and entropion repairs at 150 percent of the fee schedule amount. Append modifier 50 for bilateral repairs, and append E1-E4 if the payer requires them, Mac says.

Example: Medicare assigns 14.85 RVUs to 67917 (Repair of ectropion; extensive [e.g., tarsal strip operations]) performed in the office. Multiplying the RVUs by the 37.8975 conversion factor results in $562.77, unadjusted for geography. Appending modifier 50 to 67917 should prompt the payer to reimburse 150 percent of that amount: $844.17, $281.40 more than the unilateral service.

For unilateral repairs, append the appropriate [...]