Ophthalmology and Optometry Coding Alert

Question: An ophthalmologist in our practice performed an epilation for trichiasis, removing one lash from a patient's left lower eyelid and two lashes from the same patient's right upper eyelid. Is this procedure bilateral?

South Carolina Subscriber Answer: Depending on the method of removal, you would select epilation for trichiasis, 67820 (Correction of trichiasis; epilation, by forceps only) or 67825 (... epilation by other than forceps [e.g., by electrosurgery, cryotherapy, laser surgery]). Most often, ophthalmologists use forceps. Depending on your carrier's local medical review policies, you can bill per lash, per lid, or per eye, and there are three different methods to code your claim:

By lash: If your carrier pays by lash, which is very rare, you would code the epilation, 67820, with the number of lashes represented in the "units" area of your claim form.

By lid: If your carrier pays by lid, you will need to use the eyelid modifiers, -E1 (Upper left, eyelid), -E2 (Lower left, eyelid), -E3 (Upper right, eyelid) and -E4 (Lower right, eyelid), to represent which lid the lashes were removed from, and use modifier  -51 (Multiple procedures) to indicate that a multiple procedure was performed. For the example in your question, you should code 67820-E2 (for the lower left lid) and 67820-51-E3 (for the upper right lid).

You use modifier -51 here to indicate that lashes were removed from multiple eyelids. As for payment, you are allowed the full fee for the first line billed, and 50 percent of the fee schedule for the second through fourth procedures billed.

By eye: If your carrier pays per eye, you need to use modifier -RT (Right side) or -LT (Left side) when you operate on one eye, and modifier -50 (Bilateral procedure) if you operate on both eyes. For the example in your question, code 67820-50.

Modifier -50 will result in an allowed amount of 150 percent of the fee schedule when billing Medicare. Use two lines when billing other payers, 67820-RT, 67820-50-LT.  - Answers to Reader Questions and You Be The Coder were contributed by Raequell Duran, president, Practice Solutions, Santa Barbara, Calif.; Dennis Sandoval, MD, Eye and Facial Surgery of New Mexico, Albuquerque; and John Bell, CEO, Maine Eye Care, Waterville.