2025 CPT code 67911
(Active) Effective Date: N/A Revision Date: N/A Surgery - Surgical Procedures on the Eye and Ocular Adnexa Surgery Feed
Correction of eyelid retraction.
Modifiers may be applicable depending on the circumstances of the procedure. Refer to the CPT manual and payer-specific guidelines for appropriate modifier use.
Medical necessity is established when there is functional impairment (e.g., dry eyes, pain, blurred vision, tearing) due to eyelid retraction that is not responding to conservative management.The procedure is considered medically necessary when the functional impairment impacts the patient's daily life or vision. Cosmetic reasons alone are typically not sufficient for medical necessity.
The ophthalmologist or qualified surgeon performs the procedure.Pre-operative assessment, surgical technique, post-operative care, and follow-up are all part of the clinical responsibility.
- Surgery
- Repair (Brow Ptosis, Blepharoptosis, Lid Retraction, Ectropion, Entropion) Procedures on the Eyelids
In simple words: This surgery fixes a droopy eyelid that's pulled away from the eye. The doctor makes a small cut, moves some tissues, and adds a small piece of the patient's own tissue to help the eyelid stay in place. Stitches are adjusted to make the eyelid look and work normally.
This CPT code encompasses the surgical correction of eyelid retraction, a condition where the eyelid pulls away from the surface of the eye.The procedure involves making an incision in the upper eyelid crease, detaching the levator aponeurosis, allowing it to shrink, and inserting autologous graft material between the tendon and the tarsal plate.The surgeon adjusts sutures to ensure proper eyelid height and contour in both supine and upright positions.Note that this code does not include the acquisition of autologous graft materials (see codes 15769, 20920, 20922), correction of lid defects using fat harvested via liposuction (see codes 15773, 15774), or correction of trichiasis by mucous membrane graft (use code 67835).
Example 1: A patient presents with significant upper eyelid retraction due to Graves' ophthalmopathy (thyroid eye disease), causing dry eye symptoms and blurry vision.67911 is used to surgically correct the retraction., A patient experiences eyelid retraction following trauma to the eye.Surgical correction is required to restore function and aesthetics. 67911 is used., A patient has developed upper eyelid retraction due to an unknown cause, leading to significant irritation and discomfort.Conservative treatment has failed, and surgery is necessary. 67911 is utilized.
Detailed medical history, including onset and progression of symptoms, previous treatments, and associated medical conditions.Pre-operative photographs clearly documenting the extent of the retraction.Operative report outlining the procedure performed, including type and amount of graft material used.Post-operative photographs demonstrating the correction.Documentation of post-operative care and follow-up visits.
** This code should only be used for the surgical correction of eyelid retraction where there is a documented functional impairment.The acquisition of graft materials and other related procedures are coded separately.
- Revenue Code: P4E (EYE PROCEDURE - OTHER)
- RVU: Information not available in provided text.RVUs vary by payer and location.
- Global Days: Information not provided.The global period would likely be determined by payer-specific guidelines and the complexity of the surgery.
- Payment Status: Active
- Modifier TC rule: The application of a Technical Component (TC) modifier is not typically applicable to this code.This should be determined based on payer guidelines and clinical context.
- Fee Schedule: Historical fee schedules vary widely based on location, payer, and year.Check the relevant fee schedules for specific historical data.
- Specialties:Ophthalmology, Plastic Surgery
- Place of Service:Office, Outpatient Hospital, Ambulatory Surgery Center