Ophthalmology and Optometry Coding Alert

Question: When billing epilation (using appropriate E codes) as well as plug placement, can I also bill for E/M service codes on the same day?

Arkansas Subscriber

Answer: CPT code 67820 (correction of trichiasis; epilation, by forceps only) is identified in the CPT book as a starred procedure. CPT does not consider starred procedures as having a global period due to the variances in preoperative services. Depending on the payer, you may be able to charge a visit in addition to the epilation when performed on the same day. Coding rules for this procedure vary from payer to payer. It is important to check with your primary payers regarding their rules for starred procedures.

Medicare considers epilation a minor surgical procedure and has assigned zero postoperative days to it. As a result, you can bill a visit and the procedure on the same day with proper documentation. Check with your carrier to see if they require the use of a -25 modifier to indicate a significant separately identifiable E/M service on the day of the procedure. Some carriers require documentation of the visit and procedure so they can determine whether the visit was separate and identifiable from the procedure. (The rules for the visit are the same for a procedure whether the global is 0 days or 10 days. They both require a significant and separate service and the -25 modifier.)

Medicare has assigned code 68761 (closure of the lacrimal punctum; by plug, each) 10 postoperative days. Again, an office visit may be billed in addition to this code if a separate identifiable service is performed on the day of the plugs. Given that, documentation should include a chief complaint and brief history of present illness. There also should be documentation of an examination and an assessment and plan that addresses the problem and planned treatment. And, of course, there should be separate documentation of the procedure itself. Some commercial insurance plans do not pay for the visit on the day of the plugs because they consider the visit bundled into the procedure. Check with your major payers for their policy.