Ophthalmology and Optometry Coding Alert

Question: A Medicare patient presented with severe dry-eye syndrome. The ophthalmologist placed silicone plugs in each eyelid and has documentation showing that all four plugs were medically necessary. Do we need the eyelid modifiers in this case or are they not necessary?

Codify Subscriber

Answer: You may not be required to report the eyelid modifiers, but they can help make your claims more specific, particularly when reporting a punctal plug insertion (68761, Closure of the lacrimal punctum; by plug, each).

CPT^® provides one modifier for each eyelid: E1 for upper left, E2 for lower left, E3 for upper right, and E4 for lower right. The general rule is to use the E modifiers when a procedure can be performed on any one of the four eyelids-- but real-world coding and billing don’t always allow you to. E1-E4 are informational modifiers which do not affect payment, but they do give the payer more clinical information.

Therefore, to report the service in your question, you’ll submit the following codes:

• Line 1: 68761-E1 (1 unit)
• Line 2: 68761-E2 (1 unit)
• Line 3: 68761-E3 (1 unit)
• Line 4: 68761-E4 (1 unit).

You should use 68761 for punctal plug insertion, regardless of the type of plug you used. There is no code for removal of plugs.