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Official Description

Reconstruction of eyelid, full thickness by transfer of tarsoconjunctival flap from opposing eyelid; total eyelid, lower, 1 stage or first stage

© Copyright 2026 American Medical Association. All rights reserved.

Common Language Description

The CPT® Code 67973 refers to the surgical procedure known as the reconstruction of the eyelid, specifically the full thickness reconstruction of the lower eyelid using a tarsoconjunctival flap transferred from the opposing eyelid. This procedure is typically performed in one stage or as the first stage of a two-stage reconstruction process. The tarsoconjunctival flap is a specialized technique that utilizes tissue from the upper eyelid to repair defects in the lower eyelid, often resulting from trauma or the surgical removal of lesions. This method is part of a lid-sharing reconstruction technique, which is designed to restore both the functional and aesthetic aspects of the eyelid. The procedure involves careful dissection and manipulation of eyelid tissues, ensuring that the flap is adequately vascularized to promote healing and integration with the surrounding tissues. The reconstruction aims to restore the eyelid's structure and function, allowing for proper eyelid closure and protection of the eye. The technique may vary depending on whether the upper or lower eyelid is being reconstructed, with specific methods such as the tarsoconjunctival bridge flap or the Cutler-Beard procedure being employed based on the location and extent of the defect. Overall, this procedure is critical for patients who have experienced significant eyelid damage, as it plays a vital role in their recovery and quality of life.

© Copyright 2026 Coding Ahead. All rights reserved.

1. Indications

The procedure described by CPT® Code 67973 is indicated for patients who have experienced significant defects in the lower eyelid due to various causes. These indications include:

  • Trauma: Injuries to the eyelid that result in loss of tissue or structural integrity.
  • Surgical Excision: Removal of lesions or tumors that necessitate reconstruction of the eyelid to restore its function and appearance.
  • Congenital Defects: Conditions present at birth that affect the structure of the lower eyelid.

2. Procedure

The procedure for CPT® Code 67973 involves several detailed steps to ensure successful reconstruction of the lower eyelid. Each step is critical for achieving optimal results.

  • Step 1: A traction suture is placed in the upper eyelid margin to facilitate manipulation during the procedure. This allows the surgeon to evert the upper eyelid, providing better access to the underlying structures.
  • Step 2: The tarsus and conjunctiva of the upper eyelid are incised horizontally approximately 4 mm proximal to the lid margin. This incision is essential for creating the tarsoconjunctival flap that will be used for reconstruction.
  • Step 3: The tarsus and conjunctiva are carefully dissected away from the levator aponeurosis and the Muller muscle. This dissection is performed to free the flap and prepare it for advancement to the lower eyelid defect.
  • Step 4: The tarsoconjunctival flap is then advanced to the defect in the lower eyelid. The edges of the flap are meticulously sutured to the medial and lateral remnants of the lower lid tarsus and the lower lid conjunctiva, ensuring a secure attachment.
  • Step 5: To cover the flap, a skin graft is harvested from either the upper eyelid or the retroauricular region. Alternatively, a locally based skin flap may be advanced over the tarsoconjunctival flap for additional coverage.
  • Step 6: The flap is left in place for a duration of 4-6 weeks to allow for the development of blood supply to the lower lid from the flap, which is crucial for healing.
  • Step 7: In the second stage of the procedure, a grooved director is inserted under the flap and anterior to the globe. The flap is then divided, and the conjunctiva is sutured to the reconstructed lower lid margin.
  • Step 8: The Muller muscle and levator aponeurosis are dissected away from the overlying skin and allowed to retract, facilitating the final adjustments to the eyelid structure.
  • Step 9: The remainder of the pedicled upper lid flap is reattached to the upper lid, completing the reconstruction process.

3. Post-Procedure

After the completion of the procedure, patients are typically monitored for any signs of complications, such as infection or flap failure. The reconstructed lower eyelid will require careful management during the initial healing phase. Patients are advised to follow up with their healthcare provider to assess the healing process and ensure that the flap is integrating properly with the surrounding tissues. The flap will remain in place for 4-6 weeks, during which time patients may need to avoid certain activities that could stress the surgical site. Once the flap has established a blood supply and the healing process is well underway, further evaluations will determine the need for any additional interventions or the second stage of the procedure, if applicable.

Short Descr RECONSTRUCTION OF EYELID
Medium Descr RCNSTJ EYELID FULL THICKNESS LOWER EYELID 1 STG
Long Descr Reconstruction of eyelid, full thickness by transfer of tarsoconjunctival flap from opposing eyelid; total eyelid, lower, 1 stage or first stage
Status Code Active Code
Global Days 090 - Major Surgery
PC/TC Indicator (26, TC) 0 - Physician Service Code
Multiple Procedures (51) 2 - Standard payment adjustment rules for multiple procedures apply.
Bilateral Surgery (50) 1 - 150% payment adjustment for bilateral procedures applies.
Physician Supervisions 09 - Concept does not apply.
Assistant Surgeon (80, 82) 2 - Payment restriction for assistants at surgery does not apply to this procedure...
Co-Surgeons (62) 1 - Co-surgeons could be paid, though supporting documentation is required...
Team Surgery (66) 0 - Team surgeons not permitted for this procedure.
Diagnostic Imaging Family 99 - Concept Does Not Apply
APC Status Indicator Hospital Part B services paid through a comprehensive APC
ASC Payment Indicator Surgical procedure on ASC list in CY 2007; payment based on OPPS relative payment weight.
Type of Service (TOS) 2 - Surgery
Berenson-Eggers TOS (BETOS) P4E - Eye procedure - other
MUE 1
CCS Clinical Classification 19 - Other therapeutic procedures on eyelids, conjunctiva, cornea
E4 Lower right, eyelid
LT Left side (used to identify procedures performed on the left side of the body)
E2 Lower left, eyelid
22 Increased procedural services: when the work required to provide a service is substantially greater than typically required, it may be identified by adding modifier 22 to the usual procedure code. documentation must support the substantial additional work and the reason for the additional work (ie, increased intensity, time, technical difficulty of procedure, severity of patient's condition, physical and mental effort required). note: this modifier should not be appended to an e/m service.
50 Bilateral procedure: unless otherwise identified in the listings, bilateral procedures that are performed at the same session, should be identified by adding modifier 50 to the appropriate 5 digit code. note: this modifier should not be appended to designated "add-on" codes (see appendix d).
51 Multiple procedures: when multiple procedures, other than e/m services, physical medicine and rehabilitation services or provision of supplies (eg, vaccines), are performed at the same session by the same individual, the primary procedure or service may be reported as listed. the additional procedure(s) or service(s) may be identified by appending modifier 51 to the additional procedure or service code(s). note: this modifier should not be appended to designated "add-on" codes (see appendix d).
58 Staged or related procedure or service by the same physician or other qualified health care professional during the postoperative period: it may be necessary to indicate that the performance of a procedure or service during the postoperative period was: (a) planned or anticipated (staged); (b) more extensive than the original procedure; or (c) for therapy following a surgical procedure. this circumstance may be reported by adding modifier 58 to the staged or related procedure. note: for treatment of a problem that requires a return to the operating/procedure room (eg, unanticipated clinical condition), see modifier 78.
59 Distinct procedural service: under certain circumstances, it may be necessary to indicate that a procedure or service was distinct or independent from other non-e/m services performed on the same day. modifier 59 is used to identify procedures/services, other than e/m services, that are not normally reported together, but are appropriate under the circumstances. documentation must support a different session, different procedure or surgery, different site or organ system, separate incision/excision, separate lesion, or separate injury (or area of injury in extensive injuries) not ordinarily encountered or performed on the same day by the same individual. however, when another already established modifier is appropriate it should be used rather than modifier 59. only if no more descriptive modifier is available, and the use of modifier 59 best explains the circumstances, should modifier 59 be used. note: modifier 59 should not be appended to an e/m service. to report a separate and distinct e/m service with a non-e/m service performed on the same date, see modifier 25.
76 Repeat procedure or service by same physician or other qualified health care professional: it may be necessary to indicate that a procedure or service was repeated by the same physician or other qualified health care professional subsequent to the original procedure or service. this circumstance may be reported by adding modifier 76 to the repeated procedure or service. note: this modifier should not be appended to an e/m service.
78 Unplanned return to the operating/procedure room by the same physician or other qualified health care professional following initial procedure for a related procedure during the postoperative period: it may be necessary to indicate that another procedure was performed during the postoperative period of the initial procedure (unplanned procedure following initial procedure). when this procedure is related to the first, and requires the use of an operating/procedure room, it may be reported by adding modifier 78 to the related procedure. (for repeat procedures, see modifier 76.)
79 Unrelated procedure or service by the same physician or other qualified health care professional during the postoperative period: the individual may need to indicate that the performance of a procedure or service during the postoperative period was unrelated to the original procedure. this circumstance may be reported by using modifier 79. (for repeat procedures on the same day, see modifier 76.)
80 Assistant surgeon: surgical assistant services may be identified by adding modifier 80 to the usual procedure number(s).
82 Assistant surgeon (when qualified resident surgeon not available): the unavailability of a qualified resident surgeon is a prerequisite for use of modifier 82 appended to the usual procedure code number(s).
AS Physician assistant, nurse practitioner, or clinical nurse specialist services for assistant at surgery
CC Procedure code change (use 'cc' when the procedure code submitted was changed either for administrative reasons or because an incorrect code was filed)
E1 Upper left, eyelid
E3 Upper right, eyelid
GA Waiver of liability statement issued as required by payer policy, individual case
GC This service has been performed in part by a resident under the direction of a teaching physician
GW Service not related to the hospice patient's terminal condition
RT Right side (used to identify procedures performed on the right side of the body)
SG Ambulatory surgical center (asc) facility service
XU Unusual non-overlapping service, the use of a service that is distinct because it does not overlap usual components of the main service
Date
Action
Notes
2009-01-01 Changed Code description changed
Pre-1990 Added Code added.
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