Summary & Overview
CPT 67916: Tarsal Wedge Excision for Ectropion Repair
CPT code 67916 denotes tarsal wedge excision for repair of ectropion, a lower eyelid malposition that can lead to tearing, exposure, and irritation. This surgical code captures a common oculoplastic intervention aimed at restoring eyelid position and protecting the ocular surface. Nationally, the code is relevant for ophthalmology and oculoplastics practices, ambulatory surgical centers, hospital outpatient departments, and payers assessing coverage and coding consistency for eyelid reconstructive procedures.
Key payers in coverage and reimbursement discussions include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise clinical context for the procedure, typical sites of service, and payer coverage framing. The publication provides benchmarks and comparative policy context where available, explains common billing and coding considerations, and highlights areas where payer policies and documentation expectations can influence claim adjudication. The content is oriented to billing managers, clinical coders, and policy analysts seeking a national overview of how CPT code 67916 is used and reimbursed within surgical ophthalmology practice settings. Data not available in the input is noted where specific payer rates, associated taxonomies, and ICD-10 pairings are not provided.
Billing Code Overview
CPT code 67916 describes a surgical procedure that uses tarsal wedge excision to repair ectropion, an outward turning of the lower eyelid and eyelashes that can cause excessive tearing and eye irritation. The procedure involves removal of a wedge of tarsal tissue to tighten and reposition the lower eyelid for improved eyelid apposition and ocular surface protection.
Service Type: Eyelid reconstructive surgery (operative ophthalmic procedure)
Typical Site of Service: Ambulatory surgical center or hospital outpatient department; may also be performed in a physician office with appropriate surgical capability
Clinical & Coding Specifications
Clinical Context
A 72-year-old patient presents to the ophthalmology clinic with chronic tearing, ocular irritation, and visible outward eversion of the lower eyelid margin. Conservative measures (lubricating drops and eyelid hygiene) provided insufficient relief. Clinical exam shows lid laxity and a tarsal malposition consistent with involutional ectropion, with punctal eversion and conjunctival exposure. After informed consent, the patient is scheduled for surgical correction using tarsal wedge excision to shorten and tighten the lower eyelid, restore lid apposition, and reposition the punctum. Typical workflow: preoperative evaluation and marking in clinic; local anesthesia with monitored sedation or general anesthesia in ambulatory surgery; excision of a full-thickness or tarsal-based wedge of eyelid tissue; layered closure with attention to lid margin and punctal position; immediate postoperative assessment for eyelid contour and punctal alignment; routine postoperative medications and follow-up visits at 1 week and 4–6 weeks to assess healing and functional outcome. Typical site of service is an ambulatory surgery center or hospital outpatient department. The service type is minor reconstructive ophthalmic surgery for functional eyelid repair.
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 when a distinct E/M visit is performed and documented on the same day as the eyelid surgery (Note: was not listed in the provided modifier list; do not use if strict adherence to provided modifiers is required). |