Optometry Coding & Billing Alert

Published on Sun Sep 27, 2009 PDF

Question: What are the correct modifiers for 67820?

Pennsylvania Subscriber

Answer: Code 67820 (Correction of trichiasis; epilation) 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 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.

Modifiers RT or LT would apply if the removal of the misdirected eyelashes are performed unilaterally.

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 optometrist performs a separately identifiable service, you can charge the examination on the same day as a 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 requirements of any other visit in case of an audit.

The office visit would count as the first encounter with the patient (new patient).

In such cases, you would file the claim with modifier 25 appended to the exam or consultation code. If the exam is only a preparation for the minor procedure, then it is qualified as preoperative care and part of the global surgery package.