Summary & Overview
CPT 67938: Removal of Embedded Eyelid Foreign Body
CPT code 67938 covers surgical removal of an embedded foreign body from the eyelid to prevent injury to the eyeball. This procedure is an important, often time-sensitive ophthalmic intervention that protects vision and averts corneal or globe complications. Nationally, timely coding and appropriate site-of-service designation affect clinical workflow, billing accuracy, and payer adjudication for ophthalmology and emergency care settings.
Key payers discussed include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise review of the clinical context for the procedure, guidance on common billing considerations, and an overview of payer coverage patterns and benchmarks where available. The publication highlights typical sites of service (outpatient ophthalmology clinics, ambulatory surgical centers, and emergency departments) and situational coding factors relevant to procedural documentation.
This summary equips billing managers, coding professionals, and clinical leaders with the information needed to align documentation with clinical intent, understand common payer expectations, and anticipate areas where additional documentation may be necessary. Data not available in the input is noted where applicable.
Billing Code Overview
CPT code 67938 describes the surgical removal of an embedded foreign body from the eyelid performed to prevent damage to the eyeball. The procedure focuses on extraction of material lodged in the eyelid or its margins when retention risks corneal or ocular injury.
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Service type: Minor ophthalmic surgical procedure for foreign body removal
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Typical site of service: Outpatient ophthalmology clinic, ambulatory surgical center, or emergency department
Clinical & Coding Specifications
Clinical Context
A typical patient is a young adult or older child who presents to an ophthalmology clinic or emergency department after sustaining trauma to the eyelid (e.g., metal shaving, wood splinter, or glass fragment) or with an embedded insect or other foreign body lodged in the eyelid margin or tarsal plate. The patient reports localized pain, tearing, foreign-body sensation, eyelid swelling, or abrasion of the globe. Examination includes visual acuity, slit-lamp exam, eversion of the eyelid, fluorescein staining to assess corneal involvement, and palpation to localize the embedded material. Imaging (plain radiograph or CT) is reserved for radiopaque or deep objects.
Procedure workflow: the patient is consented and prepped in a procedure room or minor procedure suite. Topical anesthetic, local infiltration, or regional block is used based on patient comfort and location/depth of the foreign body. The eyelid is everted and the embedded material is exposed; sterile instruments (forceps, needle, curette) are used to remove the object. Hemostasis is achieved, and the wound is irrigated. If the eyelid laceration is present, repair may be performed during the same encounter. Post-procedure care includes topical antibiotic, tetanus assessment, and discharge instructions with return precautions. Documentation should include time, anesthetic, technique, description of the foreign body, estimated length of procedure, and patient tolerance.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
22 | Increased procedural services |