2025 CPT code 67966
(Active) Effective Date: N/A Revision Date: N/A Surgery - Reconstruction Procedures on the Eyelids Surgery Feed
Excision and repair of eyelid; involving lid margin, tarsus, conjunctiva, canthus, or full thickness; may include preparation for skin graft or pedicle flap with adjacent tissue transfer or rearrangement; over one-fourth of lid margin.
Modifiers -LT (left side) and -RT (right side) are commonly used to specify which eyelid was involved. Other modifiers might be used depending on the circumstances (e.g., -58 for staged procedures, -59 for distinct procedural service, -22 for increased procedural services).
Medical necessity for code 67966 is established by the presence of a significant eyelid defect that compromises vision, aesthetics, or eyelid function requiring extensive surgical repair.Documentation must clearly justify the need for the extensive repair and rule out less invasive alternatives.
The ophthalmologist or oculoplastic surgeon is responsible for performing the pre-operative assessment, surgical procedure, and post-operative care. This includes preparing the eyelid for surgery, excising the damaged tissue, repairing the defect (potentially using a skin graft or pedicle flap), and closing the incision.The surgeon may delegate certain tasks to qualified assistants.
In simple words: This code describes surgery to repair a damaged eyelid. The surgery removes the damaged part of the eyelid and fixes the area, possibly using a skin graft or moving tissue from another part of the eyelid.This is for damage covering more than a quarter of the eyelid edge.
This CPT code encompasses the surgical excision and repair of eyelid tissue exceeding one-fourth of the lid margin.The procedure may involve the lid margin, tarsus (the fibrous connective tissue supporting the eyelid), conjunctiva (the membrane lining the eyelid), and/or canthus (the corner where the eyelids meet).Preparation for a skin graft or pedicle flap, along with adjacent tissue transfer or rearrangement, may be included.The extent of the repair will determine the complexity and the level of resources required, with larger defects requiring more extensive reconstruction.
Example 1: A patient presents with a large, full-thickness eyelid laceration from a car accident requiring extensive tissue repair exceeding one-fourth of the lid margin. Code 67966 would be used to bill this extensive eyelid repair., A patient with significant ptosis (drooping eyelid) undergoes a blepharoplasty.During the surgery, more than one-fourth of the eyelid margin requires resection and reconstruction. Code 67966 would accurately reflect the surgical work., A patient with a large basal cell carcinoma on the lower eyelid undergoes Mohs micrographic surgery.After complete excision of the tumor, the resulting defect is larger than one-fourth of the lid margin, necessitating complex reconstruction with a skin graft.Code 67966 would be applicable.
Detailed medical history including the cause of eyelid damage, preoperative photographs, operative notes specifying the extent of tissue excision and reconstruction techniques employed (including graft or flap details if applicable), postoperative photographs, and any relevant pathology reports.
** Accurate coding requires a thorough understanding of the specific surgical procedures performed.The size of the defect is crucial for selecting between 67961 and 67966.Always refer to the most current CPT manual and payer guidelines for precise coding and reimbursement details.
- Revenue Code: P4E (EYE PROCEDURE - OTHER)
- RVU: The RVUs for this code will vary depending on the geographic location, practice setting (e.g., hospital outpatient department versus ambulatory surgical center), and the specific Medicare Administrative Contractor (MAC) policies in the region.Consult the appropriate fee schedules and local guidelines for the most up-to-date information.
- Global Days: The global period for this procedure is typically 90 days under Medicare, though this can vary depending on payer guidelines.
- Payment Status: Active
- Modifier TC rule: A technical component (TC) modifier is generally not applicable to code 67966, as the code describes a comprehensive surgical service.
- Fee Schedule: Historical fee schedule data for code 67966 can vary greatly by location and payer.For accurate historical fee information, consult payer-specific fee schedules and historical data from relevant sources.
- Specialties:Ophthalmology, Oculoplastic Surgery
- Place of Service:Office, Ambulatory Surgical Center, Hospital (Inpatient or Outpatient)