Crystal's MCW Coder Hub👁️ CPT 67820 - Correction of Trichiasis; Epilation, by Forceps Only
Quick Reference
wRVU: 0.17 | Global Period: 000 (0 days) | Assistant Payable: ❌ No | Bilateral Indicator: 1 | MUE: 2 per date of service
📋 Clinical Description
CPT 67820 describes the mechanical removal of misdirected eyelashes using forceps to correct trichiasis — a condition in which one or more eyelashes grow inward toward the ocular surface rather than outward from the lid margin. The aberrantly positioned lashes come into direct contact with the conjunctiva and corneal epithelium, producing persistent foreign body sensation, epiphora, photophobia, conjunctival injection, and — in untreated or chronic cases — corneal epithelial breakdown, punctate keratopathy, or frank ulceration.
Trichiasis can affect any combination of the four eyelid margins and may involve isolated lashes or multiple rows. Common underlying etiologies include chronic blepharitis, prior eyelid surgery or trauma, ocular cicatricial pemphigoid, Stevens-Johnson syndrome, chemical burns, and trachoma sequelae (B94.0). When trichiasis occurs as a consequence of inward rotation of the entire eyelid margin (entropion), entropion codes (H02.001-H02.006) should drive the diagnosis coding rather than the trichiasis-only series.
This procedure may be performed in the following clinical contexts:
- Symptomatic trichiasis — lashes causing ocular surface irritation, injection, or tearing
- Corneal threat — lashes with potential to cause epithelial breakdown or scarring
- Recurrent trichiasis — repeated forceps epilation as lashes regrow, typically every 6-8 weeks
- Post-surgical isolated lash persistence — when one or a few misdirected lashes remain following definitive lid surgery
🔬 Anatomical Considerations
| Eyelid Margin | Eyelid Modifier | Common Clinical Associations |
|---|---|---|
| Right Upper Eyelid | -E3 | Most frequently involved in trachoma-related and blepharitis-related trichiasis |
| Right Lower Eyelid | -E4 | Often associated with cicatricial disease, burns, or postoperative changes |
| Left Upper Eyelid | -E1 | Symmetric upper lid involvement common in bilateral inflammatory conditions |
| Left Lower Eyelid | -E2 | Lower lid trichiasis; less frequent than upper lid; often posttraumatic or cicatricial |
Clinical Pearl
CPT 67820 is billed per eye (or per distinct eyelid margin), not per lash removed. The MUE for this code is 2 per date of service, reflecting a maximum of one unit per eye when performed bilaterally. Removing 12 lashes from the right upper eyelid = 1 unit, not 12. Billing additional units for additional lashes on the same eyelid constitutes upcoding and will trigger MUE edits.
✅ Procedure Includes
- Slit-lamp or loupe examination to identify and map aberrantly directed lash follicles
- Mechanical grasping and extraction of misdirected eyelashes from the lid margin using sterile forceps
- Inspection of the ocular surface post-epilation to confirm lash clearance and assess corneal integrity
- Documentation of lids treated, number of lashes removed, laterality, and patient response
- Patient counseling regarding expected lash regrowth and recurrence intervals
❌ Excludes / Do Not Report Together
| Code | Description | Relationship to 67820 |
|---|---|---|
| 67825 | Correction of trichiasis; epilation by other than forceps (electrosurgery, cryotherapy, laser surgery) | Alternative method code for the same condition — mutually exclusive with 67820 for the same eyelid in the same session |
| 67830 | Correction of trichiasis; incision of lid margin | Surgical correction via lid margin incision; more definitive intervention — do not report with 67820 for the same eyelid |
| 67835 | Correction of trichiasis; incision of lid margin with free mucous membrane graft | Most extensive surgical correction; subsumes any epilation component when performed at the same site |
| 67800 | Excision of chalazion, single | Different pathology and distinct procedure; separately reportable only when involving a clearly distinct eyelid lesion with supporting documentation |
| E/M codes (992xx / 920xx) | Office visit, any level | Separately reportable only when appended with modifier -25 documenting a significant, separately identifiable E/M service beyond the routine pre-procedure assessment |
Modifier -25 Alert
CPT 67820 carries a global period of 000, designating it as a minor procedure with zero postoperative days. Medicare policy allows E/M services to be billed same-day as minor procedures only when modifier -25 is appended to the E/M code and the documentation clearly supports a separately identifiable, medically necessary service. This is one of the most frequent billing errors in ophthalmology practice — missing the -25 modifier on a same-day visit results in the E/M being bundled into the minor procedure payment and denied separately.
🌳 Code Tree - Surgery: Eyelids
CPT 67700-67999 Surgery: Eyelids, Conjunctiva, Cornea, and Ocular Adnexa
│
├── 67700-67715 Incision (Eyelid)
│ ├── 67700 Blepharotomy, drainage of abscess, eyelid
│ └── 67715 Canthotomy
│
├── 67800-67840 Excision and Destruction (Eyelid)
│ ├── 67800 Excision of chalazion; single
│ ├── 67801 Multiple chalazia, same lid
│ ├── 67805 Multiple chalazia, different lids
│ ├── 67808 Chalazion excision under general anesthesia, single or multiple
│ ├── 67810 Biopsy of eyelid
│ ├── ▶▶ 67820 ◀◀ Correction of trichiasis; epilation, by forceps only ← YOU ARE HERE
│ ├── 67825 Correction of trichiasis; epilation by other than forceps
│ ├── 67830 Correction of trichiasis; incision of lid margin
│ ├── 67835 Correction of trichiasis; incision of lid margin with free mucous membrane graft
│ └── 67840 Excision of lesion of eyelid (excluding chalazion), without closure or simple direct closure
│
├── 67850 Destruction of lesion of lid margin (up to 1 cm)
│
└── 67900-67999 Repair (Eyelid) and Other Procedures
├── 67900 Repair of brow ptosis
├── 67904 Repair of blepharoptosis; tarso-levator resection or advancement, internal approach
├── 67921 Repair of entropion; suture
└── 67923 Repair of entropion; tarsal wedge resection
💰 RVU & Reimbursement Profile
| Component | Value |
|---|---|
| Work RVU (wRVU) | 0.17 |
| Global Period | 000 (0 days) |
| Bilateral Indicator | 1 — subject to bilateral reduction rules |
| Assistant Surgeon | ❌ Not payable |
| Co-Surgeon | ❌ Not applicable |
| Team Surgery | ❌ Not applicable |
| PC/TC Split | ❌ No — procedure code only (Indicator 0) |
| Modifier -51 Exempt | No |
| Anesthesia | Topical only; no separate anesthesia billing expected |
| MUE | 2 (one unit per eye per date of service) |
Bilateral Billing Rules
When 67820 is performed on both eyes in the same session, bill as two separate line items — 1 unit with -RT (or -E3/-E4) and 1 unit with -LT (or -E1/-E2) — rather than a single line with modifier -50. Medicare and most MACs expect this code submitted as separate lines with laterality modifiers for bilateral claims. Using -50 on a single line often results in incorrect payment processing. Always verify your specific MAC guidance before submission.
🏷️ Modifier Reference
| Modifier | Name | When to Apply |
|---|---|---|
| -RT | Right Side | Procedure performed on the right eye or eyelid |
| -LT | Left Side | Procedure performed on the left eye or eyelid |
| -50 | Bilateral Procedure | Bilateral epilation same session; most payers prefer separate lines with -LT/-RT — verify before using -50 |
| -E1 | Upper Left Eyelid | Specifies upper left eyelid margin as treatment site |
| -E2 | Lower Left Eyelid | Specifies lower left eyelid margin |
| -E3 | Upper Right Eyelid | Specifies upper right eyelid margin |
| -E4 | Lower Right Eyelid | Specifies lower right eyelid margin |
| -25 | Significant, Separately Identifiable E/M | Applied to the E/M code — not 67820 — when an office visit is performed on the same date; required to separately reimburse the visit |
| -51 | Multiple Procedures | When 67820 is performed alongside other surgical procedures at the same session |
| -59 | Distinct Procedural Service | When payer inappropriately bundles 67820 with another procedure; documents distinct anatomic site, separate eyelid, or independent service |
🩺 Common ICD-10-CM Pairings
Trichiasis Without Entropion
| ICD-10 Code | Description | HCC? | Clinical Notes |
|---|---|---|---|
| H02.051 | Trichiasis without entropion, right upper eyelid | ❌ No | Most specific right-sided code; use when documentation confirms upper lid |
| H02.052 | Trichiasis without entropion, right lower eyelid | ❌ No | Right lower lid; less common than upper lid involvement |
| H02.053 | Trichiasis without entropion, right eye, unspecified eyelid | ❌ No | Use only when specific lid not documented; query provider when possible |
| H02.054 | Trichiasis without entropion, left upper eyelid | ❌ No | Left upper lid; most common left-sided site |
| H02.055 | Trichiasis without entropion, left lower eyelid | ❌ No | Left lower lid involvement |
| H02.056 | Trichiasis without entropion, left eye, unspecified eyelid | ❌ No | Use only when specific lid not documented |
| H02.059 | Trichiasis without entropion, unspecified eye, unspecified eyelid | ❌ No | Least specific; avoid unless laterality entirely absent from documentation — query provider |
Trichiasis With Entropion
| ICD-10 Code | Description | HCC? | Clinical Notes |
|---|---|---|---|
| H02.001 | Unspecified entropion, right upper eyelid | ❌ No | When trichiasis is a direct mechanical consequence of entropion; entropion drives the primary code |
| H02.004 | Unspecified entropion, left upper eyelid | ❌ No | Left-sided entropion with associated misdirected lashes |
Underlying Etiology / Complication Codes
| ICD-10 Code | Description | HCC? | Clinical Notes |
|---|---|---|---|
| B94.0 | Sequelae of trachoma | ❌ No | Code as additional diagnosis when trichiasis is a documented chronic sequela of prior trachoma; trachoma is the world’s leading infectious cause of preventable blindness |
| H18.89 | Other specified disorders of cornea | ❌ No | When corneal irritation, superficial keratopathy, or punctate erosions from the trichiatic lashes are separately documented by the provider |
Coding Specificity Reminder
The H02.05x series requires identification of laterality (right vs. left) and specific lid (upper vs. lower) as the 6th character. If the note reads “right eyelid trichiasis” without specifying upper vs. lower, query before defaulting to H02.053. Most trichiasis clinically favors the upper lid — but that is a clinical assumption, not a documented fact, and assumptions do not satisfy ICD-10-CM specificity requirements.
🏥 MS-DRG Considerations (Inpatient)
Inpatient Coding Reminder
CPT 67820 is performed exclusively in the outpatient or office setting. Inpatient admission solely for forceps epilation of eyelashes is not clinically appropriate and would not be expected or supported by any MAC, commercial payer, or utilization review body. There are no routine MS-DRG assignments for this procedure.
If a patient is admitted for an unrelated inpatient condition and trichiasis is incidentally treated during that admission, an ICD-10-PCS code may be assigned — however, it will not influence DRG grouping in any meaningful way given the minimal procedural complexity. See the ICD-10-PCS section below.
🔧 ICD-10-PCS Equivalents (Inpatient Facility Coding)
Note
Inpatient PCS coding for trichiasis epilation is exceedingly rare and will not drive DRG assignment. The following codes are provided for reference completeness only. PCS root operation selection (Extraction vs. Extirpation) may vary by facility policy — confirm with your facility compliance team.
| PCS Code | Full Description | Notes |
|---|---|---|
08DNXZZ | Extraction, Right Upper Eyelid, External Approach | Forceps removal of right upper eyelid lashes |
08DPXZZ | Extraction, Left Upper Eyelid, External Approach | Left upper eyelid |
08DQXZZ | Extraction, Right Lower Eyelid, External Approach | Right lower eyelid |
08DRXZZ | Extraction, Left Lower Eyelid, External Approach | Left lower eyelid |
PCS Character Analysis - 08DNXZZ
| Position | Character | Value | Definition |
|---|---|---|---|
| 1 | Section | 0 | Medical and Surgical |
| 2 | Body System | 8 | Eye |
| 3 | Root Operation | D | Extraction (pulling out or stripping by force) |
| 4 | Body Part | N | Upper Eyelid, Right |
| 5 | Approach | X | External |
| 6 | Device | Z | No Device |
| 7 | Qualifier | Z | No Qualifier |
PCS Root Operation Note
Extraction (D) is the most defensible root operation for forceps epilation, as it involves pulling out matter by force without cutting. Some facilities may argue Extirpation (C) — taking out solid matter from a body part. Consult your facility’s ICD-10-PCS coding policy and the PCS Official Guidelines Section B3 for root operation selection guidance. When bilateral, code each eyelid (right/left, upper/lower) as a separate PCS code line — PCS has no bilateral modifier equivalent.
📝 Coding Examples
Example 1 — Office: Bilateral Trichiasis, Upper Eyelids Only
Clinical Scenario: A 68-year-old female with chronic blepharitis presents to her ophthalmologist with bilateral ocular irritation and tearing. Slit-lamp examination confirms misdirected lashes along the right and left upper eyelid margins with superficial punctate corneal changes OU. The physician performs forceps epilation from both upper eyelid margins. No separately identifiable E/M service is documented — the encounter is solely for epilation.
| Field | Code | Rationale |
|---|---|---|
| CPT 1 | 67820-E3 | Epilation, right upper eyelid; -E3 specifies right upper lid |
| CPT 2 | 67820-E1 | Epilation, left upper eyelid; -E1 specifies left upper lid; billed as separate line |
| PDx | H02.051 | Trichiasis without entropion, right upper eyelid |
| SDx | H02.054 | Trichiasis without entropion, left upper eyelid |
Note
Two units of 67820 are appropriate here — billed for separate anatomic sites (right vs. left upper eyelid), satisfying the MUE of 2. No modifier -25 is needed because no separately identifiable E/M service was performed or documented for this encounter.
Example 2 — Office: Trichiasis Epilation + Separately Identifiable E/M Visit
Clinical Scenario: An established 74-year-old male with primary open-angle glaucoma presents for routine glaucoma follow-up. During the comprehensive exam, the physician also identifies and treats several misdirected lashes along the left lower eyelid margin causing corneal irritation. The note documents a separately identifiable medical decision-making process for glaucoma management — including IOP measurement, visual field review, and medication adjustment — distinct from the brief pre-epilation assessment.
| Field | Code | Rationale |
|---|---|---|
| CPT 1 | 99213-25 | E/M visit, established patient, low complexity; -25 modifier required on the E/M code to document separately identifiable service |
| CPT 2 | 67820-E2 | Epilation, left lower eyelid; -E2 specifies lower left lid |
| PDx | H40.1130 | Primary open-angle glaucoma, bilateral, stage unspecified — primary reason for encounter |
| SDx | H02.055 | Trichiasis without entropion, left lower eyelid |
Warning
The -25 modifier belongs on the E/M code (99213), not on 67820. This is the single most important billing rule when an office visit co-occurs with this minor procedure. Without it, the E/M payment is absorbed into the global payment for the minor procedure and denied separately. Documentation must explicitly support that the E/M service involved evaluation and management of a condition beyond the pre-epilation assessment.
Example 3 — Outpatient Clinic: Trachoma Sequelae with Bilateral Trichiasis
Clinical Scenario: A 55-year-old male with a documented history of trachoma presents to an outpatient ophthalmology clinic with recurrent bilateral upper eyelid trichiasis causing chronic corneal irritation. Forceps epilation is performed on both upper eyelid margins.
| Field | Code | Rationale |
|---|---|---|
| CPT 1 | 67820-E3 | Epilation, right upper eyelid |
| CPT 2 | 67820-E1 | Epilation, left upper eyelid; separate line item |
| PDx | H02.051 | Trichiasis without entropion, right upper eyelid |
| SDx | H02.054 | Trichiasis without entropion, left upper eyelid |
| SDx | B94.0 | Sequelae of trachoma — captures the underlying etiology driving bilateral disease and supports medical necessity |
⚠️ Common Coding Pitfalls
-
Billing multiple units per lash: 67820 is reported per eyelid margin treated, not per individual lash removed. Multiple lashes from the same eyelid = 1 unit. Billing additional units for additional lashes on the same lid constitutes upcoding and triggers MUE denials.
-
Omitting modifier -25 on a same-day E/M: This is the most frequent ophthalmology billing error associated with 67820. When an office visit occurs the same day as epilation, modifier -25 must be on the E/M code and documentation must clearly support a separately identifiable service. Missing -25 = E/M bundled and denied.
-
Using -50 instead of separate -RT/-LT lines for bilateral claims: Most MACs and commercial payers expect 67820 submitted as two separate line items with laterality modifiers, not a single line with -50. Using -50 can result in incorrect payment calculation or claim processing errors.
-
Reporting 67820 and 67825 for the same eyelid same session: These codes are mutually exclusive for the same lid margin at the same encounter. Choose the code that best reflects the dominant method used — or query the operative note if both were performed.
-
Defaulting to H02.059 without querying: Unspecified laterality codes should be the last resort, not the first choice. The H02.05x family requires lid-level specificity. Query the provider before assigning unspecified codes.
-
Failing to code the underlying etiology: When trachoma (B94.0), entropion (H02.00x), or corneal complications (H18.89) are documented, capture them as additional diagnoses. These codes substantiate medical necessity and paint a clinically complete picture for payer review.
📎 Sources
AMA CPT 2025 Professional Edition · CMS 2025 Medicare Physician Fee Schedule Final Rule (CMS-1807-F) · CMS MUE Table Q1 2025 · NCCI Policy Manual Chapter 8, CMS 2024 · ICD-10-CM Official Guidelines for Coding and Reporting FY2025 · ICD-10-PCS Official Guidelines for Coding and Reporting FY2025 · AAPC Ophthalmology Coding Reference 2024 · Eye Med Management Billing Basics: CPT 67820 · Review of Ophthalmology — Setting CPT Codes Straight with Modifiers