Summary & Overview
CPT 67923: Tarsal Wedge Excision for Lower Eyelid Entropion
CPT code 67923 captures surgical correction of lower eyelid entropion using a tarsal wedge excision. This procedure addresses inward rotation of the eyelid margin and lashes that can threaten ocular surface health and patient comfort. Nationally, accurate coding for this procedure is important for appropriate clinical documentation, surgical quality tracking, and payer adjudication for ophthalmic and oculoplastic services.
Key payers covered in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise explanation of the clinical intent of the code, the typical service setting, and the common billing modifiers used with the code (listed separately). The publication also outlines expected benchmarks and payment considerations, common documentation elements needed to support medical necessity, and potential policy or coverage nuances relevant to national payers.
The content is aimed at clinicians, coding professionals, and revenue cycle managers seeking a practical reference on clinical context and billing implications for 67923, including what to expect in claims processing and documentation priorities for ophthalmic surgical repair of entropion.
Billing Code Overview
CPT code 67923 describes a surgical repair of entropion using a tarsal wedge excision technique. The procedure addresses an inward turning of the lower eyelid and eyelashes that can cause excessive tearing, irritation, and potential corneal injury.
Service type: Ophthalmic/minor eyelid surgery
Typical site of service: Ambulatory surgical center or hospital outpatient department; may also be performed in an office-based surgical suite depending on patient and provider factors.
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Clinical & Coding Specifications
Clinical Context
A 72-year-old female presents to the ophthalmology clinic with progressive irritation, foreign body sensation, and chronic tearing of the right eye. On exam the lower eyelid margin is inwardly rotated with lashes touching the cornea and conjunctiva, consistent with involutional entropion. Conservative measures including lubricating drops and eyelash epilation provided only temporary relief. The patient is scheduled for surgical repair under monitored anesthesia care in an ambulatory surgery center.
The procedure performed is a tarsal wedge excision to correct lower eyelid entropion (CPT 67923). The clinical workflow includes preoperative evaluation (history, ocular surface assessment, consent), marking the eyelid, local or monitored anesthesia, excision of a tarsal wedge and tightening of the eyelid lamella as indicated, layered closure, postoperative topical antibiotics and ointment, and short-term follow-up within one week for wound check and suture removal. Typical site of service is an ambulatory surgery center or outpatient ophthalmic surgical suite. The typical service type is minor reconstructive eyelid surgery under local with sedation or monitored anesthesia care.
Coding Specifications
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25 | Data not available in the input. | Data not available in the input. |