How To Use CPT Code 67400

CPT 67400 describes the procedure of orbitotomy without bone flap, specifically for exploration with or without biopsy. This article will cover the official description, procedure, qualifying circumstances, appropriate usage, documentation requirements, billing guidelines, historical information and billing examples.

1. What is CPT Code 67400?

CPT 67400 can be used to describe the procedure of orbitotomy without bone flap, specifically for exploration with or without biopsy. This code is used when a provider incises and explores the orbit through an incision in the eye area, without creating a bone flap. The purpose of this procedure is to examine the orbital cavity for the presence of a tumor or other abnormality and to take a sample of any suspicious tissues for analysis and diagnosis.

2. Official Description

The official description of CPT code 67400 is: ‘Orbitotomy without bone flap (frontal or transconjunctival approach); for exploration, with or without biopsy.’

3. Procedure

1. The provider prepares the patient and administers anesthesia.
2. An incision is made in the upper eyelid crease or over the infraorbital rim, depending on the approach chosen (frontal or transconjunctival).
3. The provider explores the orbit, examining for any tumors or abnormalities.
4. If any suspicious tissue is found, the provider takes a sample for analysis and diagnosis.
5. The area is irrigated, checked for bleeding, instruments are removed, and the incision is closed.

4. Qualifying circumstances

CPT 67400 is performed when there is a need to explore the orbit without creating a bone flap. This procedure is typically done to examine the orbital cavity for tumors or other abnormalities. The provider may also perform a biopsy if any suspicious tissue is found. It is important to note that this code specifically applies to orbitotomy without bone flap and exploration with or without biopsy.

5. When to use CPT code 67400

CPT code 67400 should be used when a provider performs an orbitotomy without bone flap for exploration with or without biopsy. It is important to accurately document the procedure performed and ensure that it aligns with the official description of CPT code 67400.

6. Documentation requirements

To support a claim for CPT code 67400, the provider must document the following information:

• Patient’s diagnosis and the need for orbitotomy without bone flap
• Approach used (frontal or transconjunctival)
• Date of the procedure
• Details of the exploration, including any abnormalities found
• If a biopsy is performed, documentation of the tissue sample taken
• Confirmation of irrigation, absence of bleeding, removal of instruments, and closure of the incision

7. Billing guidelines

When billing for CPT code 67400, ensure that the procedure performed aligns with the official description. It is important to accurately document the approach used and any additional procedures, such as biopsy, if performed. It is also essential to follow any specific billing guidelines provided by the payer or coding guidelines. Report CPT code 67400 separately and do not report it if the procedure is solely for drainage (use CPT code 67405 in that case).

8. Historical information

CPT code 67400 was added to the Current Procedural Terminology system on January 1, 1990. There have been no updates or changes to the code since its addition.

9. Examples

1. A provider performs orbitotomy without bone flap to explore the orbital cavity of a patient with suspected tumor.
2. An ophthalmologist performs orbitotomy without bone flap to examine the orbit for abnormalities in a patient with unexplained eye symptoms.
3. A surgeon performs orbitotomy without bone flap and takes a biopsy of suspicious tissue in a patient with a suspected orbital mass.
4. A provider performs orbitotomy without bone flap to explore the orbit and takes a tissue sample for analysis in a patient with a history of orbital trauma.
5. An oculoplastic surgeon performs orbitotomy without bone flap to examine the orbit and takes a biopsy of a suspicious lesion in a patient with suspected orbital lymphoma.
6. A provider performs orbitotomy without bone flap to explore the orbit and takes a biopsy of a suspicious tumor in a patient with a history of metastatic cancer.
7. An ophthalmic surgeon performs orbitotomy without bone flap to explore the orbit and takes a biopsy of a suspicious lesion in a patient with suspected orbital cellulitis.
8. A provider performs orbitotomy without bone flap to explore the orbit and takes a biopsy of a suspicious mass in a patient with a history of orbital inflammatory disease.
9. An oculoplastic surgeon performs orbitotomy without bone flap to examine the orbit and takes a biopsy of a suspicious lesion in a patient with suspected orbital dermoid cyst.
10. A provider performs orbitotomy without bone flap to explore the orbit and takes a biopsy of a suspicious tumor in a patient with a history of orbital metastasis.