Ophthalmology and Optometry Coding Alert

Confusion about coding 67820 and 67825 can be a thing of the past if you can keep up with these modifiers Epilation for trichiasis -- the removal of uncomfortable misdirected eyelashes that grow in toward the eyeball -- can be a difficult procedure to code because different carriers demand different methods of billing. Coding epilation becomes even more daunting if your ophthalmologist completes the procedure bilaterally or on multiple eyelids, or if more than one eyelash is removed. The first step to correct coding is to determine your payer's accepted billing method. There are three methods of coding epilation -- per eye, per eyelid and per lash -- and your payer will only reimburse you for claims submitted by one of these methods. Typically, private payers consider billing per eye to be the correct way to handle epilation coding. Some Medicare carriers may pay by the eyelid. Trailblazer of Texas, Maryland, Delaware, Virginia and Washington, D.C., on the other hand, considers 67820 (Correction of trichiasis; epilation, by forceps only) to be a bilateral procedure -- they'll pay the same whether the doctor performs the procedure on one eye or both eyes -- but allows billing of 67825 (... epilation by other than forceps [e.g., by electro-surgery, cryotherapy, laser surgery]) up to twice per eye. You may even come across a carrier with a policy that permits billing per lash. Don't Forget the Exam If your ophthalmologist examines the eye to find the rogue eyelash, you may be entitled to reimbursement for E/M services, says Vicky Phillips, billing coordinator for Nashville Vision Associates. "Normally, if a person comes in with a complaint," Phillips says, "we'll do a level-two or -three [E/M code], depending on how extensive the exam is, and add modifier -25 (Significant, separately identifiable evaluation and management service by the same physician on the same day of the procedure or other service)." What to do: Link the E/M service to ICD-9 code 379.91 (Unspecified disorder of eye and adnexa; pain in or around eye), Phillips says. Then, if the ophthalmologist performs epilation to correct the problem, you can also code according to one of the three methods below. Method 1: Code per Eye If the carrier pays per eye, you should use the correct epilation code, 67820 or 67825, with the appropriate eye modifier, -RT or -LT, or modifier -50 (Bilateral procedure) if performed on both eyes.

Jackie Rice, accounting and insurance manager for The Eye Specialists in Virginia Beach, Va., codes per eye regardless of the carrier. If carriers reject claims, "We'll go back to them with more information," she says. "Usually, we don't have a problem."

For example, your [...]