How To Use CPT Code 67961

CPT 67961 describes the excision and repair of eyelid, involving various parts of the lid, such as the lid margin, tarsus, conjunctiva, canthus, or full thickness. 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 67961?

CPT 67961 is used to describe a surgical procedure that involves the removal and repair of damaged or diseased tissue in the eyelid. This can include the edges of the lid, the inner plate of the lid, the membrane lining of the lid, or the corner where the lids come together. The procedure may also involve the use of a skin graft or the transfer of tissue from an adjacent area to fill in the defect, up to one-fourth of the lid margin.

2. Official Description

The official description of CPT code 67961 is: ‘Excision and repair of eyelid, involving lid margin, tarsus, conjunctiva, canthus, or full thickness, may include preparation for skin graft or pedicle flap with adjacent tissue transfer or rearrangement; up to one-fourth of lid margin.’

3. Procedure

1. The provider begins by assessing the patient and determining the extent of the damage or disease in the eyelid.
2. Once the area to be excised is identified, the provider carefully removes the damaged or diseased tissue.
3. If necessary, the provider may prepare for a skin graft or pedicle flap by harvesting tissue from another area of the body.
4. The harvested tissue is then used to fill in the defect, up to one-fourth of the lid margin.
5. The provider carefully sutures the graft or flap in place and closes any remaining incisions.

4. Qualifying circumstances

CPT 67961 is typically performed on patients who have eyelid conditions that require excision and repair. These conditions may include damage or disease affecting the lid margin, tarsus, conjunctiva, canthus, or full thickness of the eyelid. The procedure may also involve the use of a skin graft or pedicle flap with adjacent tissue transfer or rearrangement. It is important to note that CPT 67961 is specifically for defects that involve up to one-fourth of the lid margin.

5. When to use CPT code 67961

CPT code 67961 should be used when a provider performs the excision and repair of the eyelid, involving up to one-fourth of the lid margin. It is important to accurately document the extent of the defect and the specific parts of the eyelid involved in the procedure.

6. Documentation requirements

To support a claim for CPT 67961, the provider must document the following information:

• The specific parts of the eyelid involved in the excision and repair
• The extent of the defect, up to one-fourth of the lid margin
• Details of any skin graft or pedicle flap procedures, including the source of the tissue
• The date of the procedure
• Any additional relevant information, such as the patient’s condition or any complications encountered

7. Billing guidelines

When billing for CPT 67961, it is important to accurately report the procedure and any associated modifiers. Additionally, it is crucial to follow the guidelines set forth by the payer regarding the reporting of eyelid procedures. It is also important to note that CPT 67961 should not be reported if the defect involves more than one-fourth of the lid margin, in which case CPT code 67966 should be used instead.

8. Historical information

CPT 67961 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 patient undergoes excision and repair of the eyelid involving the lid margin, tarsus, and conjunctiva, with a skin graft used to fill in a defect of up to one-fourth of the lid margin.
2. A provider performs excision and repair of the eyelid involving the canthus and full thickness, using a pedicle flap to reconstruct the defect.
3. An individual requires excision and repair of the eyelid involving the lid margin and tarsus, with a skin graft from the upper eyelid used to fill in the defect.
4. A patient undergoes excision and repair of the eyelid involving the conjunctiva and full thickness, with a pedicle flap used for reconstruction.
5. A provider performs excision and repair of the eyelid involving the lid margin, tarsus, and canthus, using a skin graft to fill in the defect.
6. An individual requires excision and repair of the eyelid involving the full thickness, with a pedicle flap from adjacent tissue used for reconstruction.