Optometry Coding & Billing Alert

Lash out at these 4 questions to test your trichiasis talents

Epilation to correct trichiasis is usually quick and painless - for the patient. For the optometrist, coding and billing mistakes can lead to discomfort. Take a look at these scenarios involving 67820 (Correction of trichiasis; epilation, by forceps only) and 67825 (... epilation by other than forceps), and find out how well you know your eyelash revision.

1. Using forceps, you remove one eyelash from the patient's lower left eyelid. Correct coding for this procedure would be:

a. 67820-E2
b. 67825-E2
c. 67820-LT-E2
d. 67820-50
e. None of the above

2. The patient's insurance reimburses epilation once per eye. You perform epilation on one eyelash in the upper right, one in the lower right, and one in the upper left. You should code:

a. 67820-50
b. 67820-LT and 67820-RT
c. 67820-E1, 67820-E3 and 67820-E4
d. 67820
e. either "a" or "b"

3. An OD refers a patient to an MD for cataract surgery, which he completes and bills to Medicare under the split -55 modifier (Postoperative management only). Then, during the post-op period for which the OD is responsible, he corrects trichiasis in the same eye. You should code:

a. 67820
b. 67820-24
c. 67820 and an E/M (99201-99205) or eye code (92002-92014)
d. 67820 and an E/M or eye code with modifier -24 appended
e. 67820 and an E/M or eye code with modifier -25 appended

4. A patient complains of a red eye and a "scratchy, foreign-body sensation." The doctor does a slit-lamp exam and sees a lash growing in toward the eye causing irritation. He then removes the lash. You should code:

a. 67820 linked to 374.05 (Trichiasis without entropion)
b. 67820 linked to 374.05, and the E/M service linked to 379.91 (Pain in and around eye)
c. 67820 linked to 374.05, and the E/M service linked to 379.91, with modifier -25 appended
d. 67820 and the E/M service both linked to 374.05
e. The E/M service linked to 379.91

Answers to Epilation Quiz

1. A. Modifier -E2 (Lower left, eyelid) signifies the lower left eyelid. CPT code 67825 would not be appropriate since it describes epilation by a method other than forceps.

2. E. Since the carrier reimburses epilation per eye, either method would work, since they both accurately describe a procedure done once in each eye. Individual carriers may differ in their preferences for reporting bilateral epilation.

3. D. Append modifier -24 (Unrelated evaluation and management service by the same physician during a postoperative period) to tell the carrier that the E/M service is distinct from the original cataract surgery. You can only append modifier -24 to an E/M code, not to a procedure code such as 67820.

4. C. Append modifier -25 (Significant, separately identifiable evaluation and management service by the same physician on the same day of the procedure or other service) to the E/M code to show that it is distinct from the epilation; the distinct diagnoses will reinforce this claim.

Quiz answers reviewed by Angela Dinsmore, CPC, ABO, NCLE, office manager and director of optical services at Midlothian Optical Center in Midlothian, Va; and Charles Wimbish, OD, president of Wimbish Consulting Group in Martinsville, Va.