How To Use CPT Code 67420

CPT 67420 describes a surgical procedure that involves making an incision through the side of the orbit to access and remove an expanding tumor. 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 67420?

CPT 67420 can be used to describe a surgical procedure in which the provider makes an incision through the side of the orbit, the bony cavity that holds the eyes, to remove an expanding tumor. This code is used when the provider removes a segment of bone, either temporarily as a bone flap or as a bone window left open after the procedure, to access and remove the tumor.

2. Official Description

The official description of CPT code 67420 is: ‘Orbitotomy with bone flap or window, lateral approach (eg, Kroenlein); with removal of lesion.’

3. Procedure

1. The provider makes a small incision over the lateral canthus, the outer corner of the eye where the eyelids come together, to expose the upper and lower jaw bones, as well as the cheekbone.
2. The provider extends the incision by removing the bone with a surgical drill from the side of the skull, along the deep lateral wall, up to the topmost point of the orbit.
3. The provider isolates the tumor from the surrounding tissue and removes it, taking care to prevent harm to nearby areas.
4. The provider returns the bone flap to its natural position or leaves a bone window open and attaches a suction device.
5. The provider irrigates the area, checks for bleeding, removes any instruments, and closes the incision in layers.

4. Qualifying circumstances

Patients eligible to undergo CPT 67420 are those with an expanding tumor in the orbit that requires surgical removal. The procedure is performed by a provider who has the necessary expertise and qualifications to perform an orbitotomy with a lateral approach. The patient must be appropriately prepped and anesthetized for the procedure.

5. When to use CPT code 67420

CPT code 67420 should be used when a provider performs an orbitotomy with a lateral approach and removes an expanding tumor. This code is specific to the lateral approach and the removal of a lesion. If a different approach or procedure is performed, a different CPT code should be used.

6. Documentation requirements

To support a claim for CPT 67420, the provider must document the following information:

• Patient’s diagnosis and the need for surgical removal of the tumor
• Details of the procedure, including the approach used (lateral), the bone flap or window created, and the removal of the lesion
• Date of the procedure
• Any complications or unexpected findings during the procedure
• Post-operative care instructions
• Signature of the provider performing the procedure

7. Billing guidelines

When billing for CPT 67420, ensure that the procedure meets the criteria for this specific code, including the lateral approach and the removal of a lesion. It is important to accurately document and code the procedure to ensure proper reimbursement. Report any additional procedures or services performed during the same encounter with the appropriate additional CPT codes.

8. Historical information

CPT 67420 was added to the Current Procedural Terminology system on January 1, 1990. There have been no updates to the code since its addition.

9. Examples

1. A provider performs an orbitotomy with a lateral approach and removes an expanding tumor from a patient’s orbit.
2. A patient undergoes surgery to remove a lesion in the orbit using a lateral approach and a bone flap.
3. A provider performs an orbitotomy with a lateral approach and removes a tumor, leaving a bone window open for further treatment.
4. A patient with an expanding tumor in the orbit undergoes surgery to remove the lesion using a lateral approach and a bone window.
5. A provider performs an orbitotomy with a lateral approach and successfully removes a tumor from a patient’s orbit, ensuring the surrounding areas are not harmed.
6. A patient undergoes surgery to remove a lesion in the orbit using a lateral approach, with the provider carefully returning the bone flap to its natural position.
7. A provider performs an orbitotomy with a lateral approach and removes a tumor, using a bone window to access and remove the lesion.
8. A patient with an expanding tumor in the orbit undergoes surgery to remove the lesion using a lateral approach, with the provider attaching a suction device to the bone window.
9. A provider performs an orbitotomy with a lateral approach and successfully removes a tumor from a patient’s orbit, ensuring proper irrigation and checking for bleeding.
10. A patient undergoes surgery to remove a lesion in the orbit using a lateral approach, with the provider closing the incision in layers to complete the procedure.