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CPT Code: 67820  Region: 37

Covered states:  General guidelines if your state does not have a local coverage determination

Title:  Correction of Trichiasis

Category
Minor Surgical Procedure

Description
Trichiasis, a very common lid abnormality, is defined as the misdirection of eyelashes toward the globe.

DISCLAIMER

This Medicare carrier does not have a local coverage determination (LCD) for correction of trichiasis.  The policy presented is to serve as a sample and is provided as a reference guide only and should not be construed as policy for your current Medicare carrier.  

FEE SCHEDULE



PROCEDURE DESCRIPTION

Trichiasis, a very common lid abnormality, is defined as the misdirection of eyelashes toward the globe.  The misdirected lashes may be diffuse across the entire lid or in a small segmental distribution.

Trichiasis has numerous causes, and the strategies to correct this problem are dictated by the anatomic abnormality causing the lash misdirection.

CPT Code 67820 is the correction of trichiasis; epilation, by forceps only.

COVERED DIAGNOSES

ICD-10 Diagnosis Codes



DOCUMENTATION REQUIREMENTS

All coverage criteria should be clearly documented in the patient’s medical record and made available to Medicare upon request.

The patient’s medical record should contain documentation that fully supports the medical necessity for correction of trichiasis as covered by Medicare.  This documentation includes, but is not limited to, relevant medical history, physical examination and results of pertinent diagnostic tests or procedures.

CODING GUIDELINES

Report correction of trichiasis with CPT code 67820. 

UTILIZATION GUIDELINES

This Medicare carrier has no utilization guidelines for correction of trichiasis.  It is expected that these services would be performed as indicated by current medical literature and/or current standards of optometric/ophthalmic practice.

In the absence of specific utilization guidelines, eye doctors should adhere to CMS Ruling 95-1 (V) which states that utilization of these services should be consistent with locally acceptable standards of optometric/ophthalmic practice.

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