CPT code 67820 is used for billing the correction of trichiasis, involving epilation by forceps only.
CPT code 67820 is used to denote a medical procedure involving the correction of trichiasis, which is the condition where eyelashes grow abnormally and irritate the eye. This code specifically covers the mechanical epilation, or removal, of the eyelashes.
For CPT code 67820, which pertains to the correction of trichiasis (eyelash revision), including epilation by forceps only, several modifiers may be applicable depending on the specific circumstances of the procedure and billing requirements. Here is an ordered list of potential modifiers and the reasons for their use:
1. -LT (Left side): Used to specify that the procedure was performed on the left eye or eyelid.
2. -RT (Right side): Used to specify that the procedure was performed on the right eye or eyelid.
3. -50 (Bilateral procedure): Applied when the procedure is performed on both eyes during the same operative session. It is important to check payer policies as some may require the procedure to be billed on two separate lines with -LT and -RT instead of using -50.
4. -E1 (Upper left, eyelid): Specifies that the procedure was performed on the upper left eyelid.
5. -E2 (Lower left, eyelid): Specifies that the procedure was performed on the lower left eyelid.
6. -E3 (Upper right, eyelid): Specifies that the procedure was performed on the upper right eyelid.
7. -E4 (Lower right, eyelid): Specifies that the procedure was performed on the lower right eyelid.
8. -51 (Multiple procedures): Used when multiple procedures, other than E/M services, Physical Medicine and Rehabilitation services, or provision of supplies (e.g., vaccines), are performed at the same session by the same provider. The primary procedure or service may be reported as listed. The additional procedure(s) or service(s) may be reported with modifier 51.
9. -59 (Distinct procedural service): Indicates that a procedure or service was distinct or independent from other services performed on the same day. This modifier is used to indicate that a procedure or service was distinct or independent from other non-E/M services performed on the same day.
Each modifier provides specific information that helps clarify the procedure performed for accurate billing and reimbursement. It is crucial to use these modifiers correctly to ensure compliance with payer requirements and to avoid claim denials.
CPT code 67820, which pertains to the correction of trichiasis (eyelash revision), involves procedures such as epilation by forceps or other methods. Whether this procedure is reimbursed by Medicare depends on the medical necessity as documented in the patient's medical records. Generally, if the procedure is deemed medically necessary — for example, if the trichiasis is causing eye irritation or poses a risk to the patient's vision — Medicare will likely cover it.
The reimbursement for CPT code 67820 can vary based on the geographic location and the setting in which the procedure is performed (e.g., outpatient hospital, physician's office). To determine the specific reimbursement amount, it is advisable to consult the Medicare Physician Fee Schedule (MPFS) available on the Centers for Medicare & Medicaid Services (CMS) website or through Medicare Administrative Contractors (MACs) that manage claims and payments in specific regions.
Providers should ensure that proper documentation is maintained to support the medical necessity of the procedure to facilitate appropriate reimbursement from Medicare. Additionally, checking with the local MAC for any specific coding or documentation requirements is recommended to avoid denials or delays in payment.
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