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Earn 150 Percent of RVUs for Most Eyelid Surgery

Published on Thu May 05, 2005

CMS announces changes to bilateral status for epilation and lesion excision

Misinterpreting the bilateral status of procedures like epilation or eyelid repair can have tragic consequences for your practice's bottom line. Soon, keeping the status straight will be a lot simpler - Medicare plans to update the fee schedule in July so that all of the "Eye and Ocular Adnexa" CPT codes (65091-68899), with only 10 exceptions, will have the same bilateral status.
 
Thanks in part to lobbying by the American Academy of Ophthalmology (AAO), two recent CMS transmittals announced updates to the Physician Fee Schedule Relative Value Database that will change the bilateral status of a total of 59 ophthalmological CPT codes.
 
Watch for: Transmittal 558, published on May 6, 2005, changes the bilateral status of 13 procedures from "0" to "1." The implementation date for the update is July 5, 2005, for procedures performed on or after Jan. 1, 2005. The changes will appear in the July 2005 revision of the fee schedule.

The effected CPT codes are:
 

  •  67810 - Biopsy of eyelid
     
  •  67825 - Correction of trichiasis; epilation by other  than forceps (e.g., by electrosurgery, cryotherapy, laser surgery)
     
  •  67830 - ... incision of lid margin
     
  •  67835 - ... incision of lid margin, with free mucous membrane graft
     
  •  67840 - Excision of lesion of eyelid (except chalazion) without closure or with simple direct closure
     
  •  67850 - Destruction of lesion of lid margin (up to 1 cm)
     
  •  67875 - Temporary closure of eyelids by suture (e.g., Frost suture)
     
  •  67880 - Construction of intermarginal adhesions, median tarsorrhaphy, or canthorrhaphy
     
  •  67882 - ... with transposition of tarsal plate
     
  •  67900 - Repair of brow ptosis (supraciliary, mid-forehead or coronal approach)
     
  •  67930 - Suture of recent wound, eyelid, involving   lid margin, tarsus and/or palpebral conjunctiva direct closure; partial thickness
     
  •  67935 - ... full thickness
     
  •  67938 - Removal of embedded foreign body, eyelid.
     
    What this means: Modifier indicator "1" means that the 150 percent adjustment for bilateral procedures applies. If you code any of these procedures with the bilateral modifier or report them twice on the same day by any other means (e.g., with -LT and -RT or with a "2" in the units field), Medicare carriers will base payment on the lower of the total actual charge for both sides, or 150 percent of the fee schedule amount for a single code, says Kathryn Drechsler, CPC, coder for the Bascom Palmer Eye Institute at the University of Miami.
     
    The previous status of "0" attached to these codes prevented the 150 percent adjustment from being applied,  Drechsler says. Carriers based payments on the total fee schedule amount for one code.
     
    Note: To download this transmittal, visit     www.cms.hhs.gov/manuals/pm_trans/R558CP.pdf.

    Report Most Eyelid Reconstructions Bilaterally

    An earlier CMS ruling, Transmittal 475, effective April 5, changed the bilateral status for 46 procedures under the "Eyelids" and "Conjunctiva" headings in CPT. These changes appeared in the April 2005 revision of the fee schedule.
     
    The result of the revision is that now every code in the "Eyelids - Reconstruction" section of CPT (67950-67975, with 67930-67938 to be revised in July), the "Conjunctiva" section (68020-68399) and the "Lacrimal System" section (68400-68899) has a bilateral status of "1."
     
    The change was implemented on April 4, 2005, with an effective date of Jan. 1, 2005. You may code these procedures bilaterally for dates of service on or after Jan. 1.

    Brace for Oculoplastics Changes

    The end result of all these changes? As of July, there will be only 10 codes in the "Eye and Ocular Adnexa" chapter of CPT that do not have a "1" bilateral status.

    Depending on your specialty, however, your practice may not see many changes, says Fiona Lange, CPC, coding specialist with Danbury Eye Physicians and Surgeons in Connecticut. Many of the common eyelid surgery codes, such as blepharoptosis repair (67901-67908), already have a "1" bilateral status - Lange's practice was "billing them bilaterally already." Oculoplastics specialists may see a bigger impact, Lange says.

    Avoid Reporting These 10 Procedures Bilaterally

    The procedures below will, after the July update, retain a "0" bilateral status:
     

  •  67221 - Destruction of localized lesion of choroid;  photodynamic therapy (includes intravenous infusion)
     
  •  +67225 - ... photodynamic therapy, second eye, at single session (list separately in addition to code for primary eye treatment)
     
  •  67800 - Excision of chalazion; single
     
  •  67801 - ... multiple, same lid
     
  •  67805 - ... multiple, different lids
     
  •  67808 - ... under general anesthesia and/or requiring hospitalization, single or multiple.

     The following four codes will retain a "9" bilateral status:
     

  •  65760 - Keratomileusis
     
  •  65765 - Keratophakia
     
  •  65767 - Epikeratoplasty
     
  •  65771 - Radial keratotomy.

     
    Modifier "9" indicates that the concept of bilateral surgery does not apply to these codes.
     
    Note: Read this memo online at     www.cms.hhs.gov/manuals/pm_trans/R155OTN.pdf.

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