Correction of trichiasis; epilation, by forceps only
Audit Defense & Denial Intelligence
Research-based denial patterns from OrbDoc Bill Analyzer
1. Trichiasis not causing corneal complications - observation appropriate
Common67820 (trichiasis epilation) denials occur when trichiasis documented but no corneal involvement shown. Insurance may consider epilation cosmetic or routine grooming unless corneal abrasion, irritation, or visual symptoms documented.
Common Causes
- • Few misdirected lashes noted on exam - no patient symptoms
- • No corneal fluorescein staining showing abrasion from lashes
- • Patient bothered by lash position - cosmetic concern, not medical
Resolution Strategy
Appeal with documentation showing: patient symptoms from trichiasis (foreign body sensation, tearing, photophobia, blurred vision), corneal fluorescein staining showing punctate epithelial erosions or abrasion from lash contact, photograph showing lash direction toward cornea, failed conservative measures (lubricating drops, ointment), or risk of progressive corneal damage if not removed. If asymptomatic trichiasis with no corneal involvement, observation with lubrication may be appropriate and epilation considered elective. For symptomatic trichiasis with corneal findings, epilation medically necessary.
2. Repeated epilation within global period - follow-up care included in original reimbursement
Occasional67820 has 10-day global period. Lashes regrow and repeated epilation often needed every 2-3 months. If re-epilation performed within 90 days of initial epilation, insurance may deny as follow-up care bundled with original procedure or as treatment of expected recurrence.
Common Causes
- • Same lashes epilated again 4-6 weeks after initial treatment
- • Patient returns for repeat epilation within global period (10 days)
- • Chronic recurrent trichiasis requiring frequent epilation (every 2-3 months)
Resolution Strategy
For repeat epilation within 10-day global period: bundled with original procedure, not separately billable. Do not appeal. For repeat epilation 2-3 months later: appeal arguing new lash growth (not treatment failure), different lashes involved (document location - medial vs lateral lid), or patient counseled about temporary nature of epilation and chooses this over permanent ablation (patient preference for conservative management). If repeated epliation required frequently, discuss definitive treatment options with patient: electrolysis/cryotherapy ablation (67825) for permanent lash destruction, or incisional correction (67835) for severe cases. Epilation only provides temporary relief.
Relative Value Units (RVUs)
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Clinical Information
When to Use
Removal of misdirected eyelashes (trichiasis) using forceps - temporary treatment
Common Scenarios
Documentation Requirements
- Documentation of trichiasis (misdirected lashes rubbing cornea)
- Number and location of offending lashes
- Corneal findings (abrasion, scarring, irritation)
- Method of removal (forceps epilation)
- Patient counseling on temporary nature of treatment
Coding Guidelines
Common Modifiers
Bundling Rules
- Cannot bill E&M same day unless significant separate service documented
- Local anesthesia included (if used)
- Cannot bill multiple units for same lid
- Follow-up epilation within global period not separately billable
Exclusions
- Do not use for electrolysis (use 67825)
- Cannot bill for cryotherapy ablation (use 67825)
- Do not use for incisional correction (use 67835)
- Cannot bill if no lashes actually removed
Coding Notes
Related CPT Codes
Clinical scenarios
- Documentation of trichiasis (misdirected lashes rubbing cornea)
- Number and location of offending lashes
- Corneal findings (abrasion, scarring, irritation)
- Documentation of trichiasis (misdirected lashes rubbing cornea)
- Number and location of offending lashes
- Corneal findings (abrasion, scarring, irritation)
- Documentation of trichiasis (misdirected lashes rubbing cornea)
- Number and location of offending lashes
- Corneal findings (abrasion, scarring, irritation)
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Code Details
Medicare Pricing
PFSRVU Breakdown
OPPS Details
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Ask a QuestionFrequently Asked Questions
CPT 67820 is the billing code for "Correction of trichiasis; epilation, by forceps only". Removal of misdirected eyelashes (trichiasis) using forceps - temporary treatment
Medicare pays approximately $18.11 for CPT 67820 (national average). Actual payment varies by geographic location due to GPCI adjustments. Hospital and commercial insurance rates are typically 2-4x higher than Medicare rates.
CPT 67820 has a total RVU of 3.60, broken down as: Work RVU 0.60, Practice Expense RVU 2.80, and Malpractice RVU 0.20. RVUs (Relative Value Units) determine Medicare reimbursement rates.
The most common denial reason for CPT 67820 is "Trichiasis not causing corneal complications - observation appropriate". 67820 (trichiasis epilation) denials occur when trichiasis documented but no corneal involvement shown. Insurance may consider epilation cosmetic or routine grooming unless corneal abrasion, irritation, or visual symptoms documented. Common causes include: Few misdirected lashes noted on exam - no patient symptoms; No corneal fluorescein staining showing abrasion from lashes. Appeal success rate is approximately 40-60%.
Key documentation requirements for CPT 67820 include: Documentation of trichiasis (misdirected lashes rubbing cornea); Number and location of offending lashes; Corneal findings (abrasion, scarring, irritation); Method of removal (forceps epilation). Missing or incomplete documentation is a leading cause of claim denials for this code.
Bundling considerations for CPT 67820: Cannot bill E&M same day unless significant separate service documented. Local anesthesia included (if used) Use an NCCI bundling checker to verify specific code combinations before billing.
Common modifiers for CPT 67820 include: 50 (Bilateral procedure (both eyes)), E1 (Upper eyelid, right), E2 (Lower eyelid, right). Modifiers indicate special circumstances and can affect reimbursement or prevent claim denials.
The typical time requirement for CPT 67820 is 5-10 minutes per eye. Time-based codes require documentation of the actual time spent providing the service.