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Official Description

Orbitotomy without bone flap (frontal or transconjunctival approach); with drainage only

© Copyright 2026 American Medical Association. All rights reserved.

Common Language Description

The procedure described by CPT® Code 67405 refers to an orbitotomy performed without the creation of a bone flap, utilizing either a frontal or transconjunctival approach. An orbitotomy is a surgical intervention that involves accessing the orbit, which is the bony cavity containing the eye, to explore and address various conditions affecting the ocular region. In this specific procedure, the surgeon may perform drainage of fluid collections or other interventions as necessary, depending on the nature and location of the lesion or abnormality present. The transconjunctival approach allows for access through the conjunctiva, which is the membrane covering the eye, and can be executed via an incision made in either the upper or lower conjunctival fornix. This method minimizes external scarring and provides direct access to the orbit. During the procedure, soft tissues are carefully dissected to expose the area of interest, allowing for the identification and management of any abnormalities. If a fluid collection is identified, the surgeon will incise the tissues to facilitate drainage, and any fluid obtained may be sent for laboratory evaluation. The procedure concludes with the meticulous closure of the soft tissues and conjunctiva in layers to promote optimal healing and minimize complications.

© Copyright 2026 Coding Ahead. All rights reserved.

1. Indications

The orbitotomy without bone flap, as described by CPT® Code 67405, is indicated for various conditions affecting the orbit. These may include:

  • Fluid Collections The procedure is performed to drain abscesses or other fluid accumulations within the orbit that may cause discomfort or vision impairment.
  • Lesions or Abnormalities It is indicated for the exploration and potential biopsy of lesions or abnormalities found in the orbital region, allowing for further diagnostic evaluation.
  • Infections The procedure may be necessary in cases of orbital cellulitis or other infectious processes that require drainage to alleviate symptoms and prevent complications.

2. Procedure

The orbitotomy procedure, as outlined in CPT® Code 67405, involves several key steps that ensure effective access and management of the orbital condition.

  • Step 1: Anesthesia Administration The procedure begins with the administration of appropriate anesthesia to ensure patient comfort and pain management during the surgery. This may involve local anesthesia with sedation or general anesthesia, depending on the complexity of the case and the patient's needs.
  • Step 2: Incision Creation The surgeon then makes an incision in the conjunctiva, which can be located in either the upper or lower fornix. This transconjunctival approach is chosen to minimize external scarring while providing direct access to the orbit.
  • Step 3: Dissection of Soft Tissues Following the incision, the surgeon carefully dissects the soft tissues surrounding the orbit to expose the area of interest. This dissection is performed with precision to avoid damage to surrounding structures, including nerves and blood vessels.
  • Step 4: Identification and Drainage of Fluid Collections Once the area is adequately exposed, the surgeon identifies any fluid collections or lesions present. If a fluid collection is located, the tissues are incised to allow for drainage. This step is crucial for alleviating pressure and addressing any underlying infection or pathology.
  • Step 5: Sample Collection If necessary, fluid samples may be collected during the drainage process for laboratory evaluation. This can provide valuable information regarding the nature of the fluid and any potential infectious agents.
  • Step 6: Closure of Tissues After the drainage and any additional procedures are completed, the surgeon meticulously closes the soft tissues and conjunctiva in layers. This layered closure technique is essential for promoting proper healing and minimizing the risk of complications such as infection or scarring.

3. Post-Procedure

Post-procedure care following an orbitotomy without bone flap involves monitoring the patient for any signs of complications, such as infection or excessive bleeding. Patients may be advised to avoid strenuous activities and to keep the surgical site clean and dry. Follow-up appointments are typically scheduled to assess healing and to evaluate any laboratory results from fluid samples taken during the procedure. Pain management may be provided as needed, and patients should be instructed to report any unusual symptoms, such as increased swelling or changes in vision, to their healthcare provider promptly.

Short Descr EXPLORE/DRAIN EYE SOCKET
Medium Descr ORBITOTOMY W/O BONE FLAP EXPL W/DRAINAGE ONLY
Long Descr Orbitotomy without bone flap (frontal or transconjunctival approach); with drainage only
Status Code Active Code
Global Days 090 - Major Surgery
PC/TC Indicator (26, TC) 0 - Physician Service Code
Multiple Procedures (51) 2 - Standard payment adjustment rules for multiple procedures apply.
Bilateral Surgery (50) 1 - 150% payment adjustment for bilateral procedures applies.
Physician Supervisions 09 - Concept does not apply.
Assistant Surgeon (80, 82) 1 - Statutory payment restriction for assistants at surgery applies to this procedure...
Co-Surgeons (62) 0 - Co-surgeons not permitted for this procedure.
Team Surgery (66) 0 - Team surgeons not permitted for this procedure.
Diagnostic Imaging Family 99 - Concept Does Not Apply
APC Status Indicator Hospital Part B services paid through a comprehensive APC
ASC Payment Indicator Surgical procedure on ASC list in CY 2007; payment based on OPPS relative payment weight.
Type of Service (TOS) 2 - Surgery
Berenson-Eggers TOS (BETOS) P4E - Eye procedure - other
MUE 1
CCS Clinical Classification 21 - Other extraocular muscle and orbit therapeutic procedures
22 Increased procedural services: when the work required to provide a service is substantially greater than typically required, it may be identified by adding modifier 22 to the usual procedure code. documentation must support the substantial additional work and the reason for the additional work (ie, increased intensity, time, technical difficulty of procedure, severity of patient's condition, physical and mental effort required). note: this modifier should not be appended to an e/m service.
50 Bilateral procedure: unless otherwise identified in the listings, bilateral procedures that are performed at the same session, should be identified by adding modifier 50 to the appropriate 5 digit code. note: this modifier should not be appended to designated "add-on" codes (see appendix d).
51 Multiple procedures: when multiple procedures, other than e/m services, physical medicine and rehabilitation services or provision of supplies (eg, vaccines), are performed at the same session by the same individual, the primary procedure or service may be reported as listed. the additional procedure(s) or service(s) may be identified by appending modifier 51 to the additional procedure or service code(s). note: this modifier should not be appended to designated "add-on" codes (see appendix d).
58 Staged or related procedure or service by the same physician or other qualified health care professional during the postoperative period: it may be necessary to indicate that the performance of a procedure or service during the postoperative period was: (a) planned or anticipated (staged); (b) more extensive than the original procedure; or (c) for therapy following a surgical procedure. this circumstance may be reported by adding modifier 58 to the staged or related procedure. note: for treatment of a problem that requires a return to the operating/procedure room (eg, unanticipated clinical condition), see modifier 78.
59 Distinct procedural service: under certain circumstances, it may be necessary to indicate that a procedure or service was distinct or independent from other non-e/m services performed on the same day. modifier 59 is used to identify procedures/services, other than e/m services, that are not normally reported together, but are appropriate under the circumstances. documentation must support a different session, different procedure or surgery, different site or organ system, separate incision/excision, separate lesion, or separate injury (or area of injury in extensive injuries) not ordinarily encountered or performed on the same day by the same individual. however, when another already established modifier is appropriate it should be used rather than modifier 59. only if no more descriptive modifier is available, and the use of modifier 59 best explains the circumstances, should modifier 59 be used. note: modifier 59 should not be appended to an e/m service. to report a separate and distinct e/m service with a non-e/m service performed on the same date, see modifier 25.
78 Unplanned return to the operating/procedure room by the same physician or other qualified health care professional following initial procedure for a related procedure during the postoperative period: it may be necessary to indicate that another procedure was performed during the postoperative period of the initial procedure (unplanned procedure following initial procedure). when this procedure is related to the first, and requires the use of an operating/procedure room, it may be reported by adding modifier 78 to the related procedure. (for repeat procedures, see modifier 76.)
79 Unrelated procedure or service by the same physician or other qualified health care professional during the postoperative period: the individual may need to indicate that the performance of a procedure or service during the postoperative period was unrelated to the original procedure. this circumstance may be reported by using modifier 79. (for repeat procedures on the same day, see modifier 76.)
E2 Lower left, eyelid
GC This service has been performed in part by a resident under the direction of a teaching physician
LT Left side (used to identify procedures performed on the left side of the body)
RT Right side (used to identify procedures performed on the right side of the body)
XS Separate structure, a service that is distinct because it was performed on a separate organ/structure
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