2025 CPT code 67450
(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); for exploration, with or without biopsy.
Modifiers 22, 50, 51, 52, 59, 78, and others may be applicable depending on the specifics of the procedure performed.
Medical necessity for an orbitotomy is established when a patient presents with symptoms or findings suggestive of an orbital pathology requiring surgical exploration and biopsy for diagnosis or treatment. Examples include suspected orbital tumors, traumatic injuries, inflammatory conditions, or foreign body impaction.
The ophthalmologist or oculoplastic surgeon is responsible for performing the orbitotomy, including making the incision, removing the bone flap or creating a bone window, exploring the orbit, taking biopsies, and closing the incision.They also ensure the patient's safety and comfort throughout the procedure.
In simple words: The doctor makes an incision near the eye and removes a piece of bone to explore the area around the eye. They may take tissue samples for testing to find out what is causing the problem. The bone is put back or a small opening remains depending on the needs of the patient.
This procedure involves a lateral approach orbitotomy where an incision is made through the side of the orbit (bony cavity holding the eyes). A segment of bone is removed, either temporarily as a bone flap or permanently as a bone window, to access and explore the orbital cavity.The purpose is to identify the cause of the patient's symptoms. Suspicious tissue samples are collected and sent to a lab for analysis.The procedure may include removal of bone using a high-speed burr from the greater wing of the sphenoid bone, along the deep lateral wall up to the supraorbital rim, exposing the orbital apex. The bone flap is then repositioned, or a bone window is left open, and the incision is closed in layers.
Example 1: A patient presents with a progressively enlarging mass behind their right eye causing proptosis (bulging eye).An orbitotomy with bone window is performed to access and biopsy the mass, allowing for pathological confirmation of the diagnosis and guiding subsequent treatment., A patient experiences severe orbital pain and vision loss following a traumatic orbital fracture.An orbitotomy with bone flap is performed to explore the orbit, repair the fracture, and remove any bone fragments or foreign bodies that could be compromising vision., A patient has a history of orbital tumors. A prophylactic orbitotomy with bone window is performed to closely monitor and take biopsies to detect any recurrence of the tumor.
* Preoperative diagnosis and indications for the procedure.* Detailed description of the surgical approach (lateral canthotomy, bone removal technique).* Documentation of the findings during exploration (size and location of mass, presence of fractures or foreign bodies, presence of bleeding, any other abnormalities).* Pathology report detailing the biopsy results.* Postoperative course and complications.* Imaging studies (CT, MRI) before and after surgery, if applicable.
** The specific approach and extent of bone removal may vary depending on the clinical indication and surgeon's preference.
- Revenue Code: P4E (EYE PROCEDURE - OTHER)
- RVU: Information not available in source.
- Global Days: Information not available in source.
- Payment Status: Active
- Modifier TC rule: Information not available in source.
- Fee Schedule: Information not available in source.
- Specialties:Ophthalmology, Oculoplastic Surgery
- Place of Service:Ambulatory Surgical Center, Hospital Outpatient, Office