How To Use CPT Code 67904

CPT 67904 is a code used for the repair of blepharoptosis through an external approach. This article will cover the description, procedure, qualifying circumstances, when to use the code, documentation requirements, billing guidelines, historical information, similar codes, and examples of CPT 67904 procedures.

1. What is CPT 67904?

CPT 67904 is a code used to describe the repair of blepharoptosis, or drooping eyelid, through an external approach. This procedure is performed to improve the cosmetic appearance of the eyelid or to remove any obstruction to the patient’s vision caused by the drooping eyelid.

2. 67904 CPT code description

The official description of CPT code 67904 is: “Repair of blepharoptosis; (tarso) levator resection or advancement, external approach.”

3. Procedure

The 67904 procedure involves the following steps:

1. The patient is appropriately prepped and anesthetized.
2. The provider makes an incision in the fold of the upper eyelid and dissects down to access the levator tendon.
3. The levator muscle is isolated, and the tendon is resected and shortened until the ptosis is corrected.
4. The levator aponeurosis is internally advanced to the tarsus until the eyelid margin attains the correct position.
5. The incision is closed in layers with sutures.

4. Qualifying circumstances

Patients who are eligible to receive CPT code 67904 services are those with a drooping eyelid that is either causing a cosmetic concern or obstructing their vision. The ptosis must be severe enough to warrant surgical intervention, and the patient should have tried and failed conservative treatments, such as eyelid exercises or the use of an eyelid crutch.

5. When to use CPT code 67904

It is appropriate to bill the 67904 CPT code when the provider performs a repair of blepharoptosis using an external approach, specifically through levator resection or advancement. This code should be used when the procedure is medically necessary and not solely for cosmetic purposes.

6. Documentation requirements

To support a claim for CPT 67904, the following information should be documented:

• Patient’s medical history, including the severity and duration of the ptosis
• Physical examination findings, including the degree of ptosis and any associated visual field defects
• Results of visual field tests, performed twice (once normally and once with the extra fat or tissue taped out of the way)
• Conservative treatments attempted and their outcomes
• Operative report detailing the procedure performed, including the approach used and the specific steps taken during the surgery

7. Billing guidelines

When billing for CPT code 67904, it is essential to ensure that the procedure is medically necessary and not solely for cosmetic purposes. To prove medical necessity, documentation should show that the ptosis is impairing the patient’s vision, as determined by visual field tests. Additionally, informational modifiers E1-E4 should be used to specify which eyelid the procedure was performed on. These modifiers do not affect payment but provide more clinical information to the payer.

8. Historical information

CPT 67904 was added to the Current Procedural Terminology system on January 1, 1990. The code was changed on January 1, 2001, with the previous descriptor being “Repair of blepharoptosis; (tarso)levator resection or advancement, external approach.”

9. Similar codes to CPT 67904

Five similar codes to CPT 67904 and how they differentiate are:

• CPT 67901: Repair of blepharoptosis using frontalis muscle technique with suture or other material
• CPT 67902: Repair of blepharoptosis using frontalis muscle technique with an autologous fascial sling
• CPT 67903: Repair of blepharoptosis using an internal approach, everting the eyelid
• CPT 67906: Repair of blepharoptosis using a superior rectus technique with a fascial sling
• CPT 67908: Repair of blepharoptosis using a conjunctivo-tarso-Muller’s muscle-levator resection

10. Examples

Here are 10 detailed examples of CPT code 67904 procedures:

1. A 45-year-old patient with significant ptosis in the left upper eyelid causing visual field obstruction undergoes levator resection through an external approach.
2. A 60-year-old patient with a history of long-standing right upper eyelid ptosis that has failed conservative treatments undergoes levator advancement using an external approach.
3. A 55-year-old patient with bilateral upper eyelid ptosis causing visual field defects undergoes levator resection on both upper eyelids through an external approach.
4. A 50-year-old patient with left upper eyelid ptosis and a history of unsuccessful eyelid exercises undergoes levator advancement using an external approach.
5. A 65-year-old patient with right upper eyelid ptosis causing cosmetic concerns and visual field obstruction undergoes levator resection through an external approach.
6. A 70-year-old patient with left upper eyelid ptosis and a history of failed eyelid crutch use undergoes levator advancement using an external approach.
7. A 48-year-old patient with right upper eyelid ptosis causing significant visual field defects undergoes levator resection through an external approach.
8. A 52-year-old patient with left upper eyelid ptosis and a history of unsuccessful conservative treatments undergoes levator advancement using an external approach.
9. A 58-year-old patient with bilateral upper eyelid ptosis causing cosmetic concerns and visual field obstruction undergoes levator resection on both upper eyelids through an external approach.
10. A 62-year-old patient with right upper eyelid ptosis and a history of failed eyelid exercises undergoes levator advancement using an external approach.