Optometry Coding & Billing Alert

Published on Tue Mar 15, 2016 PDF

Question: The optometrist used forceps to remove an ingrown eyelash. What CPT^® code would I report?

Nebraska Subscriber

Answer: CPT^® code 67820 (Correction of trichiasis; epilation, by forceps only) describes this procedure.

However, not all epilation procedures are considered equal: In many states, CPT^® code 67825 (…epilation by other than forceps [e.g., by electrosurgery, cryotherapy, laser surgery]) is considered surgical and therefore outside an optometrist’s scope of practice.

Bilateral rules: The Medicare Physician Fee Schedule has given CPT^® code 67820 a bilateral status of 1, which means that if the code is billed with modifier 50 (Bilateral procedure) or is reported twice on the same day (e.g., with RT and LT modifiers or with a 2 in the units field), Medicare payers will reimburse up to 150 percent of the total actual charge for one unit for both eyes.