Correction of Trichiasis by Epilation
Coding uncertainties exist for this common procedure.
By Suzanne L. Corcoran, COE

Epilation of trichiasis by forceps is the second most common minor procedure paid to ophthalmologists by Medicare. In spite of its frequency, many practices still have questions. This article should help to dispel some of the confusion.

Q: Does Medicare cover epilation? Yes, there are two methods of epilation described in CPT. One method is code 67820 (Correction of trichiasis; epilation, by forceps only), and the other is 67825 (Correction of trichiasis; epilation, by methods other than forceps, e.g., electrosurgery, cryotherapy, laser surgery).

The most common diagnosis code is trichiasis (374.05). In addition, some patients have comorbidities such as entropion (374.0x), cicatricia (704.2) or ocular
pemphigus (694.61) that add further justification.

Q: How are these codes billed? Very few Medicare carriers have published policies on these services, and there has been a great deal of confusion. Some carriers have paid per session, some per eye, some per lid, and — for a while — by lash.

Effective Jan. 1, 2005, Medicare assigned a bilateral indicator of "1" for 67820. Also, effective July 1, 2005 and retroactive to Jan. 1, 2005, the bilateral indicator for 67825 has been changed to "1." Now both codes are treated the same.

These changes permit reimbursement per eye rather than per session as was the case in 2004. The multiple surgery rule applies, so payment will be based on 150% of the allowed amount if both eyes are treated.

Q: What chart documentation is required to support the service? First, there should be a patient complaint or note explaining the medical necessity for removing the offending lash(es). As with all surgical procedures, even minor ones, an informed consent is required (verbal or written). Finally, the chart note should include an operative report describing what was done.

Q: Is an office visit covered on the same day? Sometimes. An exam may be charged on the same day as a minor surgical procedure when a separately identifiable service is performed. This may occur when: The doctor addresses another problem, condition, or disease in addition to trichiasis; the office visit is the first encounter with the patient (i.e., a new patient); or the doctor performs a procedure on just one eye, but examines the other eye for a
different reason.

In these cases, the claim is filed with modifier 25 appended to the exam or consultation code. If the exam is only a prelude to the minor procedure, then it is properly considered to be preoperative care and part of the global surgery package.

For example, if the need for epilation has previously been determined, the exam is included with the procedure. CPT adds that, "This modifier [25] is not used to report an E/M service that resulted in a decision to perform surgery." The CPT definition of modifier 25 states, "... different diagnoses are not required for reporting of the E/M services on the same date." OM

The chart shows Medicare's physician reimbursement fee schedule for 2005.