How To Use CPT Code 67450

CPT 67450 describes a specific procedure known as orbitotomy with bone flap or window, lateral approach. This article will provide an overview of CPT code 67450, including its official description, the procedure itself, qualifying circumstances, appropriate usage, documentation requirements, billing guidelines, historical information, and examples.

1. What is CPT Code 67450?

CPT 67450 is a code used to describe a 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 explore the orbital cavity. 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 purpose of this procedure is to identify the cause of a patient’s symptoms by exploring the orbital cavity and taking samples of any suspicious tissue for further analysis.

2. Official Description

The official description of CPT code 67450 is: ‘Orbitotomy with bone flap or window, lateral approach (eg, Kroenlein); for exploration, with or without biopsy.’

3. Procedure

1. During the procedure, the provider makes a small incision over the lateral canthus, the outer corner where the eyelids come together, to expose the upper and lower jaw bones, cheekbone, and zygomatic arch.
2. Using a surgical drill called a high-speed burr, the provider removes a segment of bone from the greater wing of the sphenoid bone, extending the incision along the deep lateral wall up to the supraorbital rim.
3. This allows the provider to access and explore the orbital apex, the topmost point of the orbital cavity.
4. The provider then biopsies any suspicious tissues found in the orbital cavity and submits them to a laboratory for analysis.
5. After completing the exploration and biopsy, the provider carefully returns the bone flap to its natural position or leaves a bone window open.
6. The provider then attaches a suction device, irrigates the area, checks for bleeding, removes any instruments, and closes the incision in layers.

4. Qualifying circumstances

CPT code 67450 is used for patients who require an orbitotomy with bone flap or window, lateral approach for exploration and possible biopsy. This procedure is typically performed when a patient presents with symptoms that require further investigation within the orbital cavity. It is important to note that this procedure should only be performed by a qualified healthcare professional with the necessary expertise and training.

5. When to use CPT code 67450

CPT code 67450 should be used when a provider performs an orbitotomy with bone flap or window, lateral approach for exploration and possible biopsy. It is important to accurately document the details of the procedure and ensure that it meets the criteria outlined in the official description of the code.

6. Documentation requirements

To support a claim for CPT code 67450, the provider must document the following information:

• Patient’s symptoms and the need for an orbitotomy with bone flap or window, lateral approach
• Details of the procedure, including the specific bones accessed and any bone flap or window created
• Documentation of the exploration of the orbital cavity and any biopsies performed
• Submission of any tissue samples to a laboratory for analysis
• Any additional procedures or interventions performed during the same session
• Signature of the provider performing the procedure

7. Billing guidelines

When billing for CPT code 67450, it is important to ensure that the procedure meets the specific criteria outlined in the code description. Additionally, providers should be aware of any specific guidelines or requirements from insurance companies or payers. It is also important to accurately document the details of the procedure to support the billing claim.

8. Historical information

CPT code 67450 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 patient presents with severe eye pain and vision changes. The provider performs an orbitotomy with bone flap to explore the orbital cavity and identifies a tumor that requires further biopsy.
2. A patient with a history of trauma to the eye presents with persistent swelling and discomfort. The provider performs an orbitotomy with bone window to investigate the cause of the symptoms and discovers a foreign body that requires removal.
3. A patient with a suspected orbital infection presents with redness, swelling, and fever. The provider performs an orbitotomy with bone flap to explore the orbital cavity and collects samples for culture and analysis.
4. A patient with a history of orbital fractures presents with persistent double vision. The provider performs an orbitotomy with bone window to assess the extent of the fractures and plan for corrective surgery.
5. A patient with a suspected orbital tumor presents with proptosis and visual disturbances. The provider performs an orbitotomy with bone flap to explore the orbital cavity and obtains tissue samples for histopathological examination.