Crystal's MCW Coder Hub👁️ CPT Code 67825 — Correction of Trichiasis; Epilation by Other Than Forceps
Quick Reference
wRVU: 0.56 | Global Period: 010 (10 days) | Assistant Payable: ❌ No | Bilateral Indicator: 1
📋 Clinical Description
CPT 67825 describes the destruction-based removal of misdirected eyelashes using an energy or temperature modality — most commonly electrosurgery (electrolysis or electrocautery), cryotherapy, or laser surgery (argon or Nd:YAG) — to ablate the aberrant lash and, critically, destroy the underlying follicle responsible for producing it. This distinguishes 67825 from its forceps-only counterpart (67820): forceps epilation mechanically extracts the lash but leaves the follicle intact, guaranteeing regrowth within 6-8 weeks, whereas the modalities captured under 67825 aim to permanently disable or significantly delay regrowth through thermal or cryogenic follicular destruction.
Trichiasis is the misdirection of one or more eyelashes toward the ocular surface rather than outward from the lid margin, resulting in chronic contact between lash tips and the conjunctiva or corneal epithelium. Left untreated, this produces persistent foreign body sensation, epiphora, conjunctival injection, punctate epithelial erosions, and — in advanced or cicatricial cases — corneal scarring and visual compromise. When trichiasis results from inward rotation of the entire eyelid margin (entropion), the entropion diagnosis codes drive clinical coding rather than the trichiasis-without-entropion series.
This procedure may be performed in the following clinical contexts:
- Recurrent trichiasis — patients who have undergone repeated 67820 forceps epilation cycles and require a more definitive follicular intervention
- Isolated or limited trichiasis — when only a few lashes are involved and formal lid surgery is not yet warranted
- Cicatricial trichiasis — post-inflammatory, post-radiation, or post-chemical burn cases where follicle orientation is permanently disrupted
- Post-trachoma trichiasis — sequelae of trachoma infection (B94.0) with persistent misdirected lash regrowth
- Laser trichiasis management — in patients where cryo or electro methods are preferred due to anatomy, scarring, or prior treatment failure
🔬 Anatomical & Procedural Considerations
| Modality | Mechanism | Key Notes |
|---|---|---|
| Electrolysis / Electrosurgery | DC current destroys the germinal matrix of the follicle via electrocoagulation | Most precise for isolated lashes; requires skill to avoid thermal injury to adjacent structures |
| Cryotherapy | Freeze-thaw cycles (-20°C to -25°C) destroy follicular epithelium | Effective for multiple adjacent lashes; risk of lid margin depigmentation, especially in darker skin tones; may cause temporary lid swelling |
| Laser (Argon / Nd:YAG) | Laser energy selectively ablates the pigmented follicle | Less risk of lid distortion; useful in patients with prior surgical scarring; requires appropriate laser equipment and protective eyewear protocol |
Clinical Pearl
Cryotherapy is the most commonly used modality under 67825 in the U.S. practice setting and has the highest published recurrence rate at approximately 15-20% at 1 year. Laser epilation (particularly Nd:YAG) has gained traction in academic centers for cicatricial trichiasis given its precision and reduced risk of mechanical lid trauma. Regardless of modality, the operative note must specifically document the method used — a note that says only “trichiasis treated” will not support 67825 over 67820 and may be downcoded on audit.
✅ Procedure Includes
- Pre-procedural slit-lamp or loupe examination to map aberrantly directed lash follicles and confirm treatment targets
- Topical anesthetic application and/or local infiltrative anesthesia of the affected lid margin
- Application of electrosurgical current, cryoprobe freeze-thaw cycle(s), or laser energy to the targeted lash follicle(s) with intent to ablate the germinal matrix
- Intraoperative assessment of treatment adequacy and corneal protection measures (e.g., corneal shield or protective contact lens)
- Post-procedure examination of the treated eyelid margin and ocular surface
- Routine wound care / antibiotic ointment application to the treated lid margin
- Documentation of modality used, laterality, lid(s) treated, and number of follicles treated
❌ Excludes / Do Not Report Together
| Code | Description | Relationship to 67825 |
|---|---|---|
| 67820 | Correction of trichiasis; epilation, by forceps only | Mutually exclusive for the same eyelid in the same session — report the modality actually used; do not report both for the same lid |
| 67830 | Correction of trichiasis; incision of lid margin | Surgical correction via lid margin incision — more definitive intervention; do not report with 67825 for the same eyelid at the same session |
| 67835 | Correction of trichiasis; incision of lid margin with free mucous membrane graft | Most extensive surgical correction; subsumes any epilation component — do not report 67825 for the same operative site |
| 67840 | Excision of eyelid lesion, without closure or simple direct closure | Different pathology and distinct service; 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 modifier -25 is appended to the E/M code, documenting a significant, separately identifiable E/M service beyond the routine pre-procedure assessment |
Bundling Alert — Global Period is 010, Not 000
Unlike 67820 (global period 000), 67825 carries a 010 global period — 10 postoperative days. This means that routine follow-up visits within 10 days of the procedure are bundled into the 67825 payment and cannot be separately billed to Medicare or most commercial payers. If a patient returns within the global window for an unrelated condition, append modifier -24 to the E/M code to indicate an unrelated E/M service during the postoperative period. Failure to track and apply global period rules is one of the most audited compliance issues in ophthalmology outpatient billing.
🌳 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
│ ├── 67810 Biopsy of eyelid
│ ├── 67820 Correction of trichiasis; epilation, by forceps only (Global: 000)
│ ├── ▶▶ 67825 ◀◀ Correction of trichiasis; epilation by other than forceps ← YOU ARE HERE (Global: 010)
│ ├── 67830 Correction of trichiasis; incision of lid margin (Global: 010)
│ ├── 67835 Correction of trichiasis; incision of lid margin with free mucous membrane graft (Global: 090)
│ └── 67840 Excision of lesion of eyelid, without closure or simple direct closure (Global: 010)
│
├── 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) | 0.56 (verify against current CMS MPFS for applicable year) |
| Global Period | 010 (10 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 or local infiltration; no separate anesthesia billing expected |
Bilateral Billing Rules
67825 has a bilateral indicator of 1, meaning bilateral surgery payment rules apply. When performed on both eyes in the same session, bill as two separate line items with laterality modifiers (-E1/-E2 left eye; -E3/-E4 right eye) rather than a single line with modifier -50. Medicare’s 150% bilateral rule applies: 100% for the first side, 50% for the second. Confirm your MAC’s preferred billing format — some MACs require -50 on a single line while others accept separate line items. Palmetto GBA Jurisdiction M, for example, specifically addresses bilateral modifier use for ophthalmic procedures.
🏷️ 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; verify whether your MAC prefers -50 on a single line or separate lines with -RT/-LT |
| -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 67825 — when an office visit is performed on the same date; required to separately reimburse the visit beyond the pre-procedure assessment |
| -24 | Unrelated E/M During Postoperative Period | Applied to the E/M code when a patient returns within the 10-day global window for a condition unrelated to the trichiasis procedure |
| -51 | Multiple Procedures | When 67825 is performed alongside other surgical procedures at the same session; apply to the lower-valued code |
| -59 | Distinct Procedural Service | When payers inappropriately bundle 67825 with another procedure; documents distinct anatomic site, separate eyelid, or independent service |
| -52 | Reduced Services | Procedure partially completed |
| -53 | Discontinued Procedure | Procedure stopped due to patient safety concern; document reason thoroughly |
🩺 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 upper lid code; most common site for trichiasis |
| H02.052 | Trichiasis without entropion, right lower eyelid | ❌ No | Right lower lid; less frequent than upper lid |
| H02.053 | Trichiasis without entropion, right eye, unspecified eyelid | ❌ No | Use only when documentation does not specify upper vs. lower; query provider when possible |
| H02.054 | Trichiasis without entropion, left upper eyelid | ❌ No | Left upper lid; commonly treated bilaterally with right upper lid |
| 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 lid not specified in documentation |
| 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 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 | Report as additional diagnosis when trichiasis is a documented chronic sequela of prior trachoma infection; supports medical necessity narrative |
| H18.89 | Other specified disorders of cornea | ❌ No | When corneal irritation, superficial keratopathy, or punctate erosions from trichiatic lashes are separately and explicitly documented by the provider |
Coding Specificity Reminder
The H02.05x series demands identification of both laterality (right vs. left) and lid margin (upper vs. lower) at the 6th-character level. If the documentation reads “left eyelid trichiasis” without specifying upper vs. lower, do not default to H02.056 without querying — most trichiasis favors the upper lid, but clinical assumptions are not a substitute for documented specificity. A query confirming “left upper” vs. “left lower” takes 30 seconds and produces the most specific and defensible code. ICD-10-CM specificity requirements are not optional.
🏥 MS-DRG Considerations (Inpatient)
Inpatient Coding Reminder
CPT 67825 is performed exclusively in the outpatient or office setting. There are no routine MS-DRG assignments for this procedure — inpatient admission for epilation would not be supported by any payer, MAC, or utilization review body. If a patient undergoing an inpatient admission for an unrelated diagnosis also has trichiasis treated, an ICD-10-PCS code may be assigned for completeness, but it will have no meaningful impact on DRG grouping. 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 influence DRG assignment in any meaningful way. The following codes are provided for completeness. Unlike the CPT code, which bundles all modalities under 67825, PCS root operation selection does vary by modality: Destruction (5) is appropriate for energy-based ablation (electrosurgery, laser); Extraction (D) may be applicable for cryo-mechanical techniques. Confirm with your facility’s PCS coding policy and Official Guidelines Section B3.
| PCS Code | Full Description | Applicable Modality |
|---|---|---|
085NXZZ | Destruction, Right Upper Eyelid, External Approach | Electrosurgery or laser, right upper lid |
085PXZZ | Destruction, Left Upper Eyelid, External Approach | Electrosurgery or laser, left upper lid |
085QXZZ | Destruction, Right Lower Eyelid, External Approach | Electrosurgery or laser, right lower lid |
085RXZZ | Destruction, Left Lower Eyelid, External Approach | Electrosurgery or laser, left lower lid |
PCS Character Analysis — 085NXZZ
| Position | Character | Value | Definition |
|---|---|---|---|
| 1 | Section | 0 | Medical and Surgical |
| 2 | Body System | 8 | Eye |
| 3 | Root Operation | 5 | Destruction (physical eradication of all or part of a body part by direct use of energy, force, or destructive agent) |
| 4 | Body Part | N | Upper Eyelid, Right |
| 5 | Approach | X | External |
| 6 | Device | Z | No Device |
| 7 | Qualifier | Z | No Qualifier |
PCS Root Operation: Destruction vs. Extraction
- Use Destruction (5) when energy is the primary ablative mechanism (electrosurgery, laser, and most cryotherapy applications targeting follicular destruction)
- Use Extraction (D) when the primary action is mechanical pulling/stripping — this maps more cleanly to 67820 (forceps) and may apply to cryo-epilation where the freeze-stiffened lash is mechanically extracted following cryotherapy
- When bilateral, assign separate PCS code lines for each eyelid treated — PCS has no modifier equivalent for bilateral procedures
📝 Coding Examples
Example 1 — Office: Cryotherapy Epilation, Left Upper Eyelid, Single Encounter
Clinical Scenario: A 62-year-old female with a history of recurrent trichiasis of the left upper eyelid presents after her third course of forceps epilation in 18 months. The ophthalmologist elects to perform cryotherapy epilation to ablate the offending follicles and reduce recurrence. The note documents: “Cryotherapy applied to 4 misdirected lash follicles, left upper eyelid, using double freeze-thaw technique. No corneal injury. Topical antibiotic ointment applied.” No separate E/M is documented.
| Field | Code | Rationale |
|---|---|---|
| CPT | 67825-E1 | Epilation by other than forceps (cryotherapy), left upper eyelid; -E1 specifies upper left lid |
| PDx | H02.054 | Trichiasis without entropion, left upper eyelid — most specific available code |
Note
No modifier -25 or E/M code is appropriate here — the encounter was dedicated solely to the procedure. No separately identifiable evaluation and management service is documented beyond the pre-procedure assessment, which is bundled into the 67825 global payment.
Example 2 — Office: Laser Epilation, Multiple Lids, Same Session with Separately Identifiable E/M
Clinical Scenario: An established 58-year-old male with cicatricial trichiasis secondary to prior chemical burn presents for Nd:YAG laser epilation. The physician performs laser epilation on the right upper eyelid (3 follicles) and left upper eyelid (2 follicles). The note also documents a separately identifiable evaluation of the patient’s corneal epithelial status with medical decision-making regarding topical treatment adjustment — clearly distinct from the pre-procedure trichiasis assessment.
| Field | Code | Rationale |
|---|---|---|
| CPT 1 | 99213-25 | E/M visit, established patient, low-moderate complexity; -25 on the E/M code documents separately identifiable service |
| CPT 2 | 67825-E3 | Laser epilation, right upper eyelid |
| CPT 3 | 67825-51-E1 | Laser epilation, left upper eyelid; -51 modifier on subsequent procedure line |
| PDx | H02.051 | Trichiasis without entropion, right upper eyelid — primary reason for surgical intervention |
| SDx | H02.054 | Trichiasis without entropion, left upper eyelid |
| SDx | H18.89 | Other specified corneal disorder — supports the separately identifiable E/M and corneal treatment |
Warning
Modifier -25 belongs on the E/M code (99213), not on 67825. The documentation must explicitly demonstrate evaluation and management of a condition beyond the pre-epilation assessment to survive audit. Boilerplate pre-procedure language does not qualify — the note must reflect separate medical decision-making to justify the -25 modifier.
Example 3 — Office: Electrosurgery Epilation, Bilateral Upper Lids, Trachoma Sequelae
Clinical Scenario: A 70-year-old male with a documented history of trachoma presents with recurrent bilateral upper eyelid trichiasis. The physician performs electrolysis-based epilation on the right upper eyelid and left upper eyelid. No separate E/M is documented — the visit is dedicated to the epilation procedure.
| Field | Code | Rationale |
|---|---|---|
| CPT 1 | 67825-E3 | Epilation by electrosurgery, right upper eyelid |
| CPT 2 | 67825-51-E1 | Epilation by electrosurgery, left upper eyelid; -51 on second procedure line |
| 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 underlying etiology, supports medical necessity, and completes the clinical picture for payer review |
Note
Global period reminder: Following this encounter, any routine follow-up visits within 10 days are bundled into 67825’s global payment and cannot be billed separately. If the patient returns within 10 days for a new or unrelated problem, append modifier -24 to the E/M code with documentation clearly supporting the unrelated nature of the visit.
⚠️ Common Coding Pitfalls
-
Missing documentation of modality: 67825 requires that the operative or procedure note explicitly state the method used (electrosurgery, cryotherapy, or laser). A note that says “trichiasis treated” without naming the modality cannot support 67825 over 67820 and will likely be downcoded on audit or by the payer. Documentation is the entire defense.
-
Confusing the global periods for 67820 vs. 67825: 67820 has a 000 global period (zero postoperative days); 67825 has a 010 global period (10 days). Forgetting this distinction leads to separately billing routine 10-day follow-up visits that are actually bundled into 67825, creating overpayment exposure and audit liability.
-
Billing -25 without a truly separate E/M: The pre-procedure examination for trichiasis is bundled into the minor procedure payment. Modifier -25 on a same-day E/M is only justified when documentation supports a separate, medically necessary evaluation of a distinct clinical problem. Applying -25 reflexively to every same-day visit is one of the most common ophthalmology compliance findings.
-
Reporting 67825 and 67820 for the same eyelid same session: These codes are mutually exclusive for the same lid margin at the same encounter. Report only the modality that was actually performed. If the physician used forceps to extract a lash and then applied cryotherapy to the same follicle to ablate it, 67825 is the appropriate code — it captures the more definitive and comprehensive service.
-
Defaulting to unspecified H02.059 without querying: ICD-10-CM requires laterality and lid specificity. Use H02.059 only as an absolute last resort when the record is silent and a query is not feasible. Query first.
-
Failing to track the 10-day global window: Unlike 67820’s zero-day global, 67825 requires active tracking. Billing staff must flag the procedure date and block routine follow-up visits within 10 days from separate billing. Failure to track = inadvertent overbilling = overpayment = recoupment risk.
📎 Sources
AMA CPT 2025 Professional Edition · CMS 2025 Medicare Physician Fee Schedule Final Rule (CMS-1807-F) · CMS RVU25A Relative Value Files · NCCI Policy Manual Chapter 8, CMS 2024-2025 · ICD-10-CM Official Guidelines for Coding and Reporting FY2025 · ICD-10-PCS Official Guidelines for Coding and Reporting FY2025 · AAPC Ophthalmology Coding Alert — “Code Epilation for Trichiasis Without Irritation” (2002, updated principles) · Ophthalmology Management — “Coding & Reimbursement: Trichiasis Codes” (November 2005) · Palmetto GBA Jurisdiction M — Bilateral Procedures and Modifiers Policy · Premier Eye Care — Correction of Trichiasis Coding Reference (2024)