Summary & Overview
CPT 67810: Eyelid Skin Biopsy, Eyelid Margin
CPT code 67810 designates a biopsy of a suspicious lesion on the eyelid or eyelid margin, a diagnostic minor surgical procedure used to obtain tissue for laboratory analysis. Nationally, this code matters because eyelid lesions can represent a spectrum from benign skin conditions to malignancies that require definitive diagnosis before treatment. Accurate coding and documentation affect claims processing, clinical management pathways, and downstream pathology services.
Key payers included in this analysis are Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise overview of clinical context for eyelid biopsies, typical sites of service, and common payer coverage considerations. The report also summarizes benchmark items such as utilization patterns, reimbursement considerations, and relevant policy or coding guidance where available.
This publication helps clinicians, coding staff, and policy analysts understand the clinical purpose of 67810, the payer landscape for coverage and claims processing, and where to look for further coding details or updates. Data not available in the input will be explicitly noted in those sections of the full report.
Billing Code Overview
CPT code 67810 describes a skin biopsy of the eyelid or eyelid margin. The procedure involves the provider taking a tissue sample from a suspicious area on the eyelid or its edges and submitting the specimen to a laboratory for histopathologic analysis to determine its nature.
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Service type: Minor surgical diagnostic procedure (skin biopsy)
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Typical site of service: Outpatient clinic or ambulatory surgical setting, commonly performed in dermatology, ophthalmology, or oculoplastic offices
Clinical & Coding Specifications
Clinical Context
A 67-year-old patient presents to an ophthalmology clinic with a slowly enlarging, scaly lesion on the right upper eyelid margin that occasionally bleeds and causes irritation. On slit-lamp and external exam, the surgeon documents a 4 mm raised, irregular lesion suspicious for basal cell carcinoma. After topical anesthesia and sterile prep in the office procedure room, the ophthalmologist performs a full-thickness eyelid biopsy: a small wedge excisional biopsy of the eyelid margin is taken and the specimen is placed in formalin and sent to the pathology laboratory for histologic analysis. The visit includes pre-procedure consent, local anesthetic infiltration, tissue removal, specimen labeling and handoff to pathology, and brief post-procedure wound care instructions. The typical site of service is an outpatient ophthalmology clinic or ambulatory surgery/procedure suite. This procedure is performed by ophthalmologists or oculoplastic surgeons and may precede definitive lesion excision or Mohs surgery depending on pathology results.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
25 | Significant, separately identifiable evaluation and management service by the same physician on the same day of the procedure | Use if a separate E/M visit is medically necessary and documented the same day as the biopsy |