2025 CPT code 67430
(Active) Effective Date: N/A Revision Date: N/A Surgery - Surgical Procedures on the Eye and Ocular Adnexa Surgery Feed
Orbitotomy with bone flap or window, lateral approach (e.g., Kroenlein); with removal of foreign body.
Modifiers may be applicable depending on the circumstances. For example, modifier 51 (multiple procedures) might be used if additional procedures are performed during the same session.Modifier 22 (increased procedural services) may be used to indicate additional work.Modifiers 50 (bilateral procedure) and 78/79 (unplanned return to OR) might apply in specific situations. Consult the official CPT guidelines for appropriate modifier application.
Medical necessity for this procedure is established by the presence of a foreign body in the orbit causing visual impairment, pain, infection, or other complications that warrant surgical intervention.Imaging studies should confirm the location and size of the foreign body.
The ophthalmologist or oculoplastic surgeon is responsible for the pre-operative assessment, procedure, and post-operative care. This may include patient preparation and anesthesia administration (if not delegated to an anesthesiologist), incision and bone removal using a high-speed burr, foreign body identification and removal, repair of the orbital roof or creation of a bone window, irrigation, hemostasis, and closure of the incision.
In simple words: The doctor makes a cut near the outer corner of the eye to reach the bone around the eye socket.A piece of bone is either temporarily removed or left open as a window to get to and take out a foreign object. The bone is then put back (if removed) and the cut is closed.
This procedure involves a lateral approach orbitotomy with creation of a bone flap or window.The surgeon makes an incision through the side of the orbit (bony cavity holding the eye), removing a segment of bone to access and remove a foreign body.The bone may be temporarily removed as a bone flap, or a bone window may be left open after the procedure.The specific bones involved may include the superior maxilla, inferior frontal bone, zygoma, zygomatic arch, and the greater wing of the sphenoid bone. The approach exposes the orbital apex. Following foreign body removal, the bone flap is repositioned (if applicable), and the incision is closed in layers. Irrigation and hemostasis are performed.
Example 1: A patient presents after a high-velocity projectile injury with a metallic foreign body embedded in the orbital apex.An orbitotomy with bone window is performed to safely remove the foreign body, and the bone window is left open for monitoring., A patient experiences persistent orbital pain and swelling following an assault. Imaging reveals a bone fragment impinging on the optic nerve.A Kroenlein orbitotomy with bone flap is performed to remove the fragment, and the bone flap is replaced., A patient presents with a history of orbital trauma and persistent diplopia (double vision). An exploratory orbitotomy with bone flap is performed to identify and address potential nerve entrapment or damage caused by a previously undiagnosed foreign body.
* Preoperative and postoperative photographs documenting the extent of injury, surgical approach, and outcome.* Detailed operative report outlining the surgical steps, types of instruments used, location of the foreign body, and tissue findings.* Imaging studies (CT scan or MRI) to accurately localize the foreign body preoperatively and document post-operative healing.* Anesthesia records, if applicable.* Pathology report, if tissue samples are collected.* Patient's medical history and informed consent form.* Postoperative course notes.
** This code encompasses various approaches and techniques. The specific anatomical location and the type of foreign body removed should be documented.Appropriate documentation is crucial for accurate coding and reimbursement.The approach, whether a bone flap or window is used, must be documented.
- Revenue Code: P4E (EYE PROCEDURE - OTHER)
- Payment Status: Active
- Modifier TC rule: The Technical Component (TC) modifier may apply if the procedure is performed by a facility.This is determined by payer policies and may require separate billing by the physician for professional services.
- Specialties:Ophthalmology, Oculoplastic Surgery
- Place of Service:Inpatient Hospital, Ambulatory Surgical Center, Outpatient Hospital