How To Use CPT Code 21280

CPT code 21280 describes a procedure called medial canthopexy, which involves tightening the structures that support the inner corner of the eyelids. This article will cover the description, procedure, qualifying circumstances, appropriate usage, documentation requirements, billing guidelines, historical information and billing examples.

1. What is CPT Code 21280?

CPT code 21280 is used to describe the procedure known as medial canthopexy. This procedure involves tightening the structures that support the inner corner of the eyelids. It is performed to improve the appearance of the eye or to address drainage problems of the lacrimal sac, which is the upper portion of the tear duct.

2. Official Description

The official description of CPT code 21280 is: ‘Medial canthopexy (separate procedure).’ It is important to note that for medial canthoplasty, a different code, 67950, should be used.

3. Procedure

During a medial canthopexy procedure, the healthcare provider begins by making small incisions in the medial canthus, which is the inner corner of the eyelids. They then identify the supporting structures and proceed to tighten the medial canthus. This is done by passing a suture through the underlying periosteum, the posterior limb of the medial canthal tendon, and into the medial edge of the tarsus, which is the tissue of the inner corner of the eyelid. The provider then irrigates the area, checks for bleeding, and closes the incision.

4. Qualifying circumstances

CPT code 21280 is used when a patient requires tightening of the structures supporting the inner corner of the lower eyelid. This procedure may be performed for cosmetic purposes to improve the appearance of the eye or for medically necessary reasons to address drainage problems of the lacrimal sac. Preauthorization is typically recommended for this procedure to indicate the medical necessity to the insurer.

5. When to use CPT code 21280

CPT code 21280 should be used when a healthcare provider performs a medial canthopexy procedure to tighten the structures supporting the inner corner of the eyelids. It should not be used for medial canthoplasty, which involves joining the upper and lower eyelids to the puncta, the openings of the lacrimal canaliculi.

6. Documentation requirements

To support a claim for CPT code 21280, the healthcare provider must document the following information:

• Patient’s diagnosis or reason for the procedure
• Details of the procedure performed, including the specific structures tightened
• Date of the procedure
• Any complications or additional procedures performed
• Signature of the healthcare provider performing the procedure

7. Billing guidelines

When billing for CPT code 21280, ensure that the procedure performed is a medial canthopexy and not a medial canthoplasty. It is important to note that preauthorization is often recommended for this procedure. There are no specific guidelines regarding reporting CPT code 21280 with other codes.

8. Historical information

CPT code 21280 was added to the Current Procedural Terminology system on January 1, 1990. There have been no updates to the code since its addition.

9. Similar codes to CPT 21280

While there are no similar codes specifically related to medial canthopexy, there are other codes within the range of repair, revision, and/or reconstruction procedures on the head (CPT codes 21120-21296) that may be applicable for other procedures involving the head region.

9. Examples

1. A patient undergoes a medial canthopexy procedure to tighten the structures supporting the inner corner of their eyelids for cosmetic purposes.
2. A healthcare provider performs a medial canthopexy to address drainage problems of the lacrimal sac in a patient with tear duct issues.
3. A patient undergoes a medial canthopexy procedure to improve the appearance of their eye after trauma or injury.
4. A healthcare provider performs a medial canthopexy to correct eyelid malposition in a patient with eyelid laxity.
5. A patient undergoes a medial canthopexy procedure to address complications from a previous eyelid surgery.
6. A healthcare provider performs a medial canthopexy to tighten the structures supporting the inner corner of the eyelids in a patient with age-related changes in the eye area.
7. A patient undergoes a medial canthopexy procedure to improve the symmetry of their eyes.
8. A healthcare provider performs a medial canthopexy to address functional issues related to the eyelids, such as excessive tearing.
9. A patient undergoes a medial canthopexy procedure to correct eyelid malposition caused by a congenital condition.
10. A healthcare provider performs a medial canthopexy to improve the appearance of the eye in a patient with ptosis.