How To Use CPT Code 67966

CPT 67966 describes the excision and repair of the eyelid, involving various components 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 67966?

CPT 67966 can be used to describe the surgical procedure performed to remove damaged or diseased tissue from the eyelid. This may involve excising the edges of the lid, the lid’s inner plate, the membrane lining of the lid, or the corner where the lids come together. The procedure may also include the preparation for a skin graft or pedicle flap with adjacent tissue transfer or rearrangement, especially if the defect is more than one-fourth of the lid margin.

2. Official Description

The official description of CPT code 67966 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; over one-fourth of lid margin.’

3. Procedure

1. The provider begins by assessing the patient’s eyelid condition and determining the extent of the damage or disease.
2. If the defect involves more than one-fourth of the lid margin, the provider may decide to perform an excision and repair procedure.
3. The provider administers appropriate anesthesia and prepares the patient for the surgery.
4. Using surgical instruments, the provider carefully removes the damaged or diseased tissue from the eyelid, ensuring to excise the specific components mentioned in the code description.
5. If necessary, the provider may perform a skin graft or pedicle flap procedure to fill in the defect. This involves taking tissue from another area of the body or using adjacent tissue to reconstruct the eyelid.
6. The provider sutures the graft or flap in place and closes any remaining incisions.
7. Post-operative care and follow-up appointments are scheduled to monitor the healing process and address any complications.

4. Qualifying circumstances

CPT 67966 is typically performed on patients with eyelid conditions that require excision and repair. These conditions may include eyelid tumors, trauma, or other abnormalities. The procedure is performed by a qualified healthcare professional who has the necessary training and expertise in eyelid surgery. The specific components involved in the procedure, such as the lid margin, tarsus, conjunctiva, canthus, or full thickness, must be addressed to qualify for this code.

5. When to use CPT code 67966

CPT code 67966 should be used when the provider performs an excision and repair procedure on the eyelid, involving the specified components mentioned in the code description. It is important to ensure that the defect is more than one-fourth of the lid margin to meet the criteria for this code. If the defect is smaller, a different code, such as 67961, may be more appropriate.

6. Documentation requirements

To support a claim for CPT 67966, the provider must document the following information:

• The patient’s diagnosis and the need for the excision and repair procedure
• The specific components of the eyelid involved in the procedure
• The details of any skin graft or pedicle flap procedures performed
• The date and duration of the surgery
• Any complications or post-operative care provided
• The provider’s signature and credentials

7. Billing guidelines

When billing for CPT 67966, ensure that the procedure meets the criteria outlined in the code description. It is important to accurately document the specific components involved in the excision and repair procedure. Modifier E1, E2, E3, or E4 can be used to designate the involved eyelid. It is also essential to follow any additional guidelines provided by the payer to ensure proper reimbursement.

8. Historical information

CPT 67966 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 undergoes excision and repair of the eyelid to remove a tumor involving the lid margin and conjunctiva.
2. A provider performs an excision and repair procedure on an eyelid with trauma, involving the tarsus and canthus.
3. A patient with a defect in the eyelid’s full thickness undergoes an excision and repair procedure with a skin graft.
4. An individual requires an excision and repair procedure on the eyelid, involving the lid margin and tarsus, due to an abnormality.
5. A provider performs an excision and repair procedure on an eyelid with extensive damage, involving the conjunctiva and canthus.