Ophthalmology and Optometry Coding Alert

Question: We recently treated a patient for chalazion removal from the right and left eyelids. The code in question is 67805 (excision of chalazion; multiple, different lids). Does multiple mean more than one lesion or more than one lid? Would we bill the 67805 twice with -RT and -LT or will the one code cover the total procedure? Furthermore, if multiple represents the lesions, would we use 67805 or 67800 -RT and -LT? Our patient had only one lesion per lid.

Bethany Gullett, Medical Billing Manager
Memphis Eye & Cataract Associates, TN

Answer: The proper way to code for chalazion excisions on this patient, who had one chalazion on each lid, is to use 67800 (excision of chalazion; single) with modifiers, says Bonnie Barton, administrator of Augusta Eye Associates, a four-ophthalmologist practice in Waynesboro, VA. You should bill 67800-RT and 67800-LT. And if you want to be really thorough, you should use the lid modifiers as well. These are -E1 (upper left eyelid), -E2 (lower left eyelid), -E3 (upper right eyelid), and -E4 (lower right eyelid). Code 67805 is for the removal of multiple lesions on different lids on the same eye. This could mean two chalazions on the upper lid and one on the lower. But it could not mean only one on each upper lid of both eyes. So if the patient above had one chalazion on each upper eyelid, you would code the procedure: 67800-LT-E1 and 67800-RT-E3.