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Official Description

Reconstruction of eyelid, full thickness by transfer of tarsoconjunctival flap from opposing eyelid; second stage

© Copyright 2026 American Medical Association. All rights reserved.

Common Language Description

The CPT® Code 67975 refers to the reconstruction of the eyelid using a full-thickness tarsoconjunctival flap that is transferred from the opposing eyelid, specifically during the second stage of a two-stage surgical procedure. This technique is employed to address eyelid defects that may arise due to trauma or extensive surgical excision of lesions. The procedure utilizes a lid-sharing reconstruction method, which is tailored based on whether the upper or lower eyelid is being reconstructed. For the lower eyelid, a common approach is the tarsoconjunctival bridge flap, also known as the modified Hughes procedure. This involves creating a flap from the upper eyelid, which is then advanced to repair the defect in the lower eyelid. The reconstruction process is meticulous, requiring precise incisions and suturing to ensure proper alignment and healing. The flap is typically secured in place for a period of 4 to 6 weeks to allow for adequate blood supply development. In the second stage, further refinements are made to the eyelid structure, including suturing the conjunctiva to the reconstructed lower lid margin and reattaching any remaining flap components. This comprehensive approach ensures functional and aesthetic restoration of the eyelid, which is critical for both vision and appearance.

© Copyright 2026 Coding Ahead. All rights reserved.

1. Indications

The procedure described by CPT® Code 67975 is indicated for the reconstruction of eyelid defects resulting from various conditions. These include:

  • Trauma: Eyelid injuries that compromise the structural integrity of the eyelid.
  • Surgical Excision: Removal of lesions or tumors that necessitate reconstruction to restore the eyelid's function and appearance.

2. Procedure

The procedure involves several detailed steps to ensure effective reconstruction of the eyelid. These steps include:

  • Step 1: A traction suture is placed in the upper eyelid margin to facilitate eversion. The upper eyelid is then everted, allowing access to the tarsus and conjunctiva.
  • Step 2: An incision is made horizontally 4 mm proximal to the lid margin, followed by dissection of the tarsus and conjunctiva away from the levator aponeurosis and Muller muscle to create the tarsoconjunctival flap.
  • Step 3: The flap is advanced to the defect in the lower eyelid, where its edges are sutured to the medial and lateral remnants of the lower lid tarsus and conjunctiva.
  • Step 4: A skin graft, either harvested from the upper eyelid or the retroauricular region, is used to cover the flap. Alternatively, a locally based skin flap may be advanced over the tarsoconjunctival flap.
  • Step 5: The flap is left in place for 4 to 6 weeks to allow for the development of blood supply to the lower lid.
  • Step 6: In the second stage of the procedure, a grooved director is inserted under the flap and anterior to the globe, and the flap is divided.
  • Step 7: The conjunctiva is sutured to the reconstructed lower lid margin, while the Muller muscle and levator aponeurosis are dissected away from the overlying skin and allowed to retract.
  • Step 8: The remainder of the pedicled upper lid flap is reattached to the upper lid.
  • Step 9: For upper eyelid reconstruction, a skin-muscle-conjunctival flap is developed using the lower lid, which is then advanced into the defect of the upper lid and sutured to the defect margins.
  • Step 10: The upper eyelid flap is left in place for 6 to 8 weeks, after which it is divided at the planned reconstructed upper lid margin, and the remainder of the pedicled flap is reattached to the lower eyelid.

3. Post-Procedure

Post-procedure care involves monitoring the surgical site for signs of infection and ensuring proper healing of the reconstructed eyelid. Patients are typically advised to avoid any activities that may strain the eyelid or disrupt the healing process. Follow-up appointments are essential to assess the integration of the flap and the overall aesthetic and functional outcomes of the reconstruction. The flap remains in place for a designated period to ensure adequate blood supply and healing before any further surgical interventions are performed.

Short Descr RECONSTRUCTION OF EYELID
Medium Descr RCNSTJ EYELID FULL THICKNESS SECOND STAGE
Long Descr Reconstruction of eyelid, full thickness by transfer of tarsoconjunctival flap from opposing eyelid; second 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) 1 - Statutory payment restriction for assistants at surgery applies to this procedure...
Co-Surgeons (62) 0 - Co-surgeons not permitted for this procedure.
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
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.
E4 Lower right, eyelid
RT Right side (used to identify procedures performed on the right side of the body)
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).
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.
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.)
CC Procedure code change (use 'cc' when the procedure code submitted was changed either for administrative reasons or because an incorrect code was filed)
CR Catastrophe/disaster related
E1 Upper left, eyelid
E2 Lower 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
LT Left side (used to identify procedures performed on the left side of the body)
SG Ambulatory surgical center (asc) facility service
XS Separate structure, a service that is distinct because it was performed on a separate organ/structure
XU Unusual non-overlapping service, the use of a service that is distinct because it does not overlap usual components of the main service
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