2025 CPT code 67961
(Active) Effective Date: N/A Revision Date: N/A Surgery - Surgical Procedures on the Eye and Ocular Adnexa Surgery Feed
Excision and repair of eyelid tissue, involving the lid margin, tarsus, conjunctiva, or canthus; up to one-fourth of the lid margin.
Modifiers E1, E2, E3, and E4 can be used to specify the involved eyelid (upper left, lower left, upper right, lower right, respectively). Other modifiers may be applicable depending on the circumstances of the procedure (e.g., 50 for bilateral procedures, 51 for multiple procedures, 22 for increased procedural services).
The medical necessity for this procedure is established by the presence of a lesion or injury requiring surgical excision and repair.The lesion could be cancerous, benign, or traumatic.The documentation should clearly support the need for surgical intervention.
The ophthalmologist or oculoplastic surgeon performs the excision and repair of the eyelid tissue. This includes prepping the patient, administering anesthesia, excising the diseased tissue, closing the incision, and potentially harvesting and suturing a skin graft or performing a pedicle flap.
In simple words: This code covers surgery to remove and repair damaged eyelid tissue. The surgery might include the edge of the eyelid, the inner support structure, the lining of the eyelid, or the corner where the eyelids meet.The amount of tissue removed is limited to a small portion of the eyelid edge. The surgeon will stitch the area closed or possibly use a skin graft from another area of the body.
This CPT code encompasses the surgical excision and repair of damaged or diseased eyelid tissue.The procedure may involve the lid margin, tarsus (the fibrous support structure of the eyelid), conjunctiva (the membrane lining the eyelid), or canthus (the corner where the eyelids meet). The extent of the excision is limited to up to one-fourth of the eyelid margin.Repair may include primary closure or preparation for a skin graft or pedicle flap with adjacent tissue transfer or rearrangement.The code does not include more extensive repairs requiring additional codes.
Example 1: A patient presents with a small basal cell carcinoma on the lower eyelid margin. The surgeon excises the lesion and performs primary closure., A patient sustains a laceration involving the upper eyelid margin, extending approximately one-fifth of its length. The surgeon repairs the laceration with direct closure., A patient has a benign lesion involving the medial canthus and a small portion of the upper eyelid margin. The surgeon performs an excision and closes the resulting defect with adjacent tissue rearrangement.
* Detailed operative report describing the procedure performed, including the location and size of the excision and the type of repair (primary closure, skin graft, or pedicle flap).* Preoperative photographs documenting the lesion's size and location.* Postoperative photographs documenting the surgical site's appearance.* Pathology report confirming the diagnosis of excised tissue.* Anesthesia record.
** Careful documentation is essential to ensure accurate coding and appropriate reimbursement.Understanding the limitations of this code (excision up to one-fourth of the lid margin) is crucial to avoid coding errors.If the procedure involves more extensive repair, additional codes should be reported.
- Revenue Code: P4E (EYE PROCEDURE - OTHER)
- RVU: This information is not available in the provided source.Consult the current year's Medicare Physician Fee Schedule or other relevant payer's fee schedule for RVU data.
- Global Days: The information regarding the global surgical period for this code is not specified in the provided source.Further research may be required to obtain this data.
- Payment Status: Active
- Modifier TC rule: The information regarding Technical Component (TC) modifier application is not explicitly stated in the source.Consult additional guidelines for clarification.
- Fee Schedule: Fee schedule information varies by payer and year.Consult historical fee schedules (e.g., from CMS) for past reimbursement data.
- Specialties:Ophthalmology, Oculoplastic Surgery, Plastic Surgery
- Place of Service:Office, Ambulatory Surgery Center (ASC), Hospital Outpatient Department