How To Use CPT Code 67445

CPT 67445 describes a surgical procedure known as orbitotomy with bone flap or window, lateral approach. This article will provide an overview of the code, including its official description, the procedure involved, qualifying circumstances, appropriate usage, documentation requirements, billing guidelines, historical information, and similar codes.

1. What is CPT Code 67445?

CPT 67445 is used to report a specific surgical procedure called orbitotomy with bone flap or window, lateral approach. This procedure involves making an incision through the side of the orbit, the bony cavity that holds the eyes, to access and relieve pressure on other structures. The provider may remove a segment of bone temporarily during the procedure as a bone flap or leave a bone window open after the procedure. The code was added to the Current Procedural Terminology system on January 1, 1992.

2. Official Description

The official description of CPT code 67445 is: ‘Orbitotomy with bone flap or window, lateral approach (eg, Kroenlein); with removal of bone for decompression.’ It is important to note that for optic nerve sheath decompression, a different code, 67570, should be used.

3. Procedure

1. When performing CPT 67445, the provider begins by making a small incision over the lateral canthus, the outer corner of the eye where the eyelids come together.
2. Through this incision, the provider exposes the superior maxilla, inferior frontal bone, zygoma, and zygomatic arch, which make up the cheekbone.
3. Using a high-speed burr, the provider extends the incision along the deep lateral wall up to the supraorbital rim, exposing the orbital apex.
4. The provider then drills the bone and removes enough bony tissue to relieve the pressure on the structures within the orbit.
5. Great care is taken to avoid any harm to nearby areas, and the bone is returned to its natural position.
6. The provider may choose to repair the orbital roof or leave a bone window and attach a suction device.
7. After irrigating the area and checking for bleeding, the provider removes any instruments and closes the incision in layers.

4. Qualifying circumstances

CPT 67445 is typically performed on patients who require decompression of the orbit due to an expanding tumor mass or other conditions causing increased pressure. It is important to note that this code specifically refers to the lateral approach, and other codes should be used for different approaches or explorations of the orbit. The procedure should be performed by a qualified healthcare professional with the necessary expertise.

5. When to use CPT code 67445

CPT code 67445 should be used when the provider performs an orbitotomy with bone flap or window using a lateral approach. It is important to ensure that the procedure meets the specific criteria outlined in the code description. If the procedure involves a different approach or exploration, a different code should be used.

6. Documentation requirements

To support a claim for CPT code 67445, the provider must document the following information:

• Patient’s diagnosis and the need for orbitotomy with bone flap or window
• Details of the procedure, including the approach used and any bone removal for decompression
• Date of the procedure
• Any complications or unexpected findings
• Signature of the performing provider

7. Billing guidelines

When billing for CPT code 67445, it is important to ensure that the procedure meets the specific criteria outlined in the code description. The provider should also be aware of any additional guidelines or requirements set by the payer. It is important to note that CPT code 67445 should not be reported with other codes in the 67400-67450 range unless additional approaches or explorations are performed.

8. Historical information

CPT code 67445 was added to the Current Procedural Terminology system on January 1, 1992. There have been no updates or changes to the code since its addition.

9. Examples

1. A patient undergoes orbitotomy with bone flap or window, lateral approach for decompression due to an expanding tumor mass.
2. A provider performs orbitotomy with bone flap or window, lateral approach to relieve pressure on structures within the orbit caused by a vascular malformation.
3. An individual requires orbitotomy with bone flap or window, lateral approach for decompression due to an orbital cellulitis infection.
4. A patient undergoes orbitotomy with bone flap or window, lateral approach to remove a foreign body causing pressure on the structures within the orbit.
5. A provider performs orbitotomy with bone flap or window, lateral approach to relieve pressure on structures within the orbit caused by an orbital pseudotumor.
6. An individual requires orbitotomy with bone flap or window, lateral approach for decompression due to Graves’ ophthalmopathy.
7. A patient undergoes orbitotomy with bone flap or window, lateral approach to relieve pressure on structures within the orbit caused by a traumatic injury.
8. A provider performs orbitotomy with bone flap or window, lateral approach to remove a tumor causing pressure on the structures within the orbit.
9. An individual requires orbitotomy with bone flap or window, lateral approach for decompression due to an orbital abscess.
10. A patient undergoes orbitotomy with bone flap or window, lateral approach to relieve pressure on structures within the orbit caused by an orbital cyst.