2025 CPT code 67405
(Active) Effective Date: N/A Revision Date: N/A Surgery - Surgical Procedures on the Eye and Ocular Adnexa Surgery Feed
Orbitotomy without bone flap (frontal or transconjunctival approach); with drainage only.
Modifiers may be applicable depending on the circumstances of the procedure, such as 51 (multiple procedures), 59 (distinct procedural service), or others. Consult the CPT codebook and payer guidelines for specific modifier rules.
Medical necessity for 67405 is established when a patient presents with an orbital abscess or other fluid collection causing significant pain, visual impairment, or risk of infection spread.Appropriate documentation supporting the diagnosis and the need for surgical drainage is crucial for successful claim processing.
The ophthalmologist or oculoplastic surgeon is responsible for this procedure.Their responsibilities include patient preparation and anesthesia, making the incision, identifying and draining the fluid collection, irrigating the area, controlling bleeding, removing instruments, and closing the incision. Post-operative care may also be included depending on the complexity of the case.
In simple words: The doctor makes a small cut near the eye, without removing any bone, to drain a pocket of pus or fluid caused by an infection or cyst.The area is then cleaned and the cut is closed.
This CPT code encompasses an orbitotomy procedure performed without creating a bone flap, utilizing either a frontal or transconjunctival approach.The procedure involves making an incision in the orbital region to access and drain an abscess or other fluid accumulation, typically resulting from infection or cysts.The approach may involve an incision in the upper eyelid crease (frontal) or an incision over the infraorbital rim with eversion of the lower eyelid (transconjunctival). Following drainage, irrigation and hemostasis are ensured before wound closure.
Example 1: A patient presents with a painful, swollen eyelid and a suspected orbital abscess.The surgeon performs a 67405 to drain the abscess., A patient with a history of orbital cysts experiences recurrent inflammation and fluid build-up. The surgeon performs a 67405 to drain the cyst and alleviate symptoms., Following trauma to the orbital region, a patient develops an orbital hematoma which requires drainage. The surgeon performs a 67405 to drain the hematoma.
Complete medical history, physical examination findings detailing the location, size and characteristics of the abscess or cyst, operative report describing the approach, drainage technique, and irrigation, pathology report if applicable, post-operative notes documenting healing and complications.
** Always cross-reference with the official CPT codebook and payer-specific guidelines for the most up-to-date information on coding, reimbursement, and medical necessity criteria.
- Revenue Code: P4E (EYE PROCEDURE - OTHER)
- RVU: This information is not available in the provided sources.Refer to the official CPT codebook and current payer-specific reimbursement guidelines for RVU values.
- Global Days: This information is not available in the provided sources. The global period for this procedure will vary depending on payer and other factors. Refer to the appropriate guidelines.
- Payment Status: Active
- Modifier TC rule: The TC modifier is not usually applicable to this code, as it generally refers to technical components of procedures.However, payer-specific rules should be checked.
- Fee Schedule: Historical fee schedule information is not provided in the source data. Refer to historical CPT codebooks and payer-specific databases.
- Specialties:Ophthalmology, Oculoplastic Surgery
- Place of Service:Office, Ambulatory Surgical Center, Inpatient Hospital