Ophthalmology and Optometry Coding Alert

Question: What are the correct modifiers for 67820?

Pennsylvania Subscriber

Answer: Code 67820 (Correction of trichiasis; epilation, by forceps only) applies to the removal of misdirected eyelashes.

Medicare assigned the bilateral indicator "1" for 67820. Retroactive to Jan. 1, 2005, the bilateral indicator for 67825 has been changed to "1." Due to this, both codes are now treated the same.

This change has an impact on how this service is reimbursed. The changes made effective in 2005 permit reimbursement per eye rather than per session as was the case in 2004. The rule on multiple surgery applies, so payment will be based on 150 percent of the allowed amount if both eyes are treated. You would report these modifiers with 67820:

• E1 if the epilation is carried out on the upper left eyelid

• E2 if on the lower left eyelid

• E3 if on the upper right eyelid

• E4 if the epilation was done on the lower right eyelid.

You don't have to use modifiers RT/LT unless your local carrier has instructed you to do so.

Watch out: This service requires a patient complaint to support the medical necessity for removing the offending eyelash or eyelashes. In a case when the ophthalmologist performs a separately identifiable service, you can charge for the E/M workup provided on the same day as the minor procedure. But keep in mind that the office visit has to be able to stand on its own as a visit with all the required components of history, exam and medical decision making in the event of an audit.

In such cases, you would file the claim with modifier 25 appended to the E/M code. If the physician only performs a focused exam as a preparation for the minor procedure, then it qualifies as preoperative care and part of the global surgery package.