Summary & Overview
CPT 67935: Direct Closure of Full-Thickness Eyelid Laceration
CPT code 67935 represents the direct surgical closure of a full-thickness eyelid laceration of recent origin. This code captures repair when the eyelid wound completely penetrates the eyelid tissue and may involve the margins, conjunctival lining, or tarsal plate. Accurate use of the code is important for capturing care delivered in acute settings and for tracking utilization of ophthalmic soft-tissue repair nationally.
Key payers discussed include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a national perspective on where CPT code 67935 is used, typical sites of service such as emergency departments, urgent care centers, and outpatient ophthalmology or minor procedure clinics, and clinical context around managing full-thickness eyelid lacerations.
The publication provides benchmarks and comparative policy context for reimbursement and billing practice, highlights common modifiers and coding considerations where available, and outlines relevant clinical circumstances for correct code selection. Data not available in the input will be noted as such. The goal is to inform billing professionals, ophthalmic providers, and policy analysts about the clinical intent, service setting, and payer coverage patterns tied to CPT code 67935 at a national level.
Billing Code Overview
CPT code 67935 describes the direct closure of a full-thickness eyelid laceration of recent origin. The procedure involves suturing wound edges of the eyelid where the injury completely penetrates the eyelid and may involve the margins, conjunctival lining, or tarsal plate.
Service type: Minor surgical repair (eyelid laceration repair), direct closure.
Typical site of service: Emergency department, urgent care, or outpatient surgical/ophthalmology clinic for prompt management of acute eyelid lacerations.
Clinical & Coding Specifications
Clinical Context
A 34-year-old male presents to an urgent care clinic after a dog bite to the left upper eyelid sustained earlier the same day. The wound is a full-thickness eyelid laceration that penetrates the eyelid margin and tarsal plate with minimal contamination and no globe injury on exam. The clinical workflow includes initial triage, visual acuity and eye exam, topical and local anesthesia (field block), meticulous irrigation and debridement, layered direct repair of the eyelid with suturing of tarsal plate and skin, tetanus update if indicated, and post-procedure instructions for wound care and ophthalmic follow-up within 24–48 hours.
Typical site of service: Emergency department or urgent care clinic; can also occur in ambulatory surgical center or ophthalmology outpatient clinic for non-emergent lacerations.
Service type: Minor surgical procedure — eyelid repair with layered closure (direct closure) for recent full-thickness eyelid laceration.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
25 | Significant, separately identifiable evaluation and management service by the same physician on the day of a procedure | Use when a distinct E/M visit is performed and documented in addition to the eyelid repair (note: 25 was not in the provided modifier list; follow strict rule: Data not available in the input.) |