Optometry Coding & Billing Alert

Published on Thu Aug 24, 2006 PDF

Question: What is the proper way to code for epilation of lashes? We used to bill per lash removed up to a maximum dollar amount, but that does not seem to work now. What modifiers are best to use?


New York Subscriber


Answer: Most carriers only want you to report 67820 (Correction of trichiasis; epilation, by forceps only) once per date of service. Although some carriers have reimbursed for epilation for each eyelash, most do not.

There may be some instances in which you append eyelid modifiers (E1, Upper left, eyelid; E2, Lower left, eyelid; E3, Upper right, eyelid; E4, Lower right, eyelid) to 67820, but in most cases you won-t.

For the epilation codes, CPT 2006 references AMA's July 1998 CPT Assistant, which says that the intent of 67820 is to report the service per procedure, not per eyelash or per eyelid. Many Medicare Part B carriers have used that reference to amend or clarify their rules for 67820, so you can no longer report 67820 once for each eyelid you treat.

Medicare has indicated a bilateral status of -1- for procedure code 67820. So, when the service is performed bilaterally and reported with modifier 50 (Bilateral procedure) or RT (Right side) and LT (Left side) on separate lines of the claim form, Part B carriers should base payment on 150 percent of the fee schedule amount.