Ophthalmology and Optometry Coding Alert

Question: We saw a patient with several eyelashes growing in toward her eyes, so the physician removed the offending eyelashes. Should we report the removals per eye, per eyelid, or per eyelash?

Codify Subscriber

 Answer: To report this service, you should use the correct epilation code, 67820 (Correction of trichiasis; epilation, by forceps only) or 67825 (...  epilation by other than forceps [e.g., by electrosurgery, cryotherapy, laser surgery]) and report it per eye. Ifperformed on both eyes, you'll append the correct eye modifier, RT or LT, or modifier 50 (Bilateral procedure).

For example, your optometrist, by use of forceps, removes one lash from a patient's left lower eyelid and two lashes from the same patient's right upper eyelid. You should code 67820-50 if the carrier is Medicare, and 67820-LT, 67820-50-RT for private carriers who prefer that you bill this way.

"When the above codes are submitted on a claim, report the codes per eye; not per eyelash or per eyelid," says Palmetto GBA in its trichiasis policy. "When performed unilaterally, the quantity-billed field (days/units) must be 'one,'" the policy says.

If you instead report the procedure bilaterally, report one unit of the appropriate code with modifier 50 appended, Palmetto advises. Other payers such as private carriers, however, may ask you to use modifiers LT or RT instead.