Outpatient Facility Coding Alert

Reader Question:

Remember to Use Eyelid Modifiers in Certain Cases

Published on Thu Jul 21, 2016

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Question: The incisional biopsy of eyelid skin and lid margin is performed multiple times on the same date of service. We understand the bilateral surgical indicator for this procedure is 1, which means a 150 percent payment adjustment for bilateral procedure applies to the professional component. We have several questions about how to bill these procedures.

If we perform one biopsy on the right eyelid and one on the left eyelid, do we bill 67810 at 1 unit with modifier 50?
What if we perform this procedure on the right upper eyelid as well as right lower eyelid? Do we report 67810 at two units or on two separate claim lines?
What if we perform 4 incisional biopsies of eyelid on the same day, on the right and left upper and lower eyelids?

Michigan Subscriber

Answer: Code 67810 (Incisional biopsy of eyelid skin including lid margin) represents a unilateral procedure. If performed bilaterally, some payers require that the service be reported twice with modifier 50 (Bilateral procedure) appended to the second code. Other payers require identification of the service only once with modifier 50 appended. Still others may require modifiers RT (Right side) and LT (Left side). Check with individual payers to verify their guidelines.

Modifier 50 identifies a procedure performed identically on the opposite side of the body (mirror image). If the provider performs different incisional biopsies of the eyelid on the same day, use the eyelid modifiers instead of LT or RT: E1 for upper left, E2 for lower left, E3 for upper right, and E4 for lower right.