CPT® Code 67908

The procedure described by CPT® Code 67908 involves the surgical repair of blepharoptosis, which is characterized by the drooping or sagging of the upper eyelid. This condition typically arises due to weakness in the levator palpebrae muscle, which is responsible for elevating the eyelid. The surgical technique employed in this procedure is known as conjunctivo-tarso-Muller's muscle levator resection, commonly referred to as Muller muscle conjunctiva repair (MMCR) or the Fasanella-Servat repair. During the operation, the upper eyelid is everted, allowing the surgeon to expose the tarsal plate, which is the dense connective tissue that provides structure to the eyelid. To facilitate the repair, three temporary traction sutures are strategically placed near the superior margin of the tarsal plate—one positioned medially, one laterally, and one centrally. These sutures serve to lift and hold the section of the tarsal plate that is to be excised. The ends of these sutures are clamped with artery forceps to maintain tension. Additionally, three more temporary traction sutures are placed near the margin of the everted eyelid, emerging close to the superior fornix and aligned with the first set of sutures. This arrangement supports the conjunctival and tarsal wedge for subsequent suturing. The surgeon then marks the planned incision lines based on previously obtained measurements and uses a blade breaker knife to create a groove incision. Scissor tips are inserted into this groove to excise the tarsal plate. Following the excision, the wound is repaired using a continuous buried suture, which is temporarily tied at both ends. The shape of the eyelid is assessed, and adjustments are made to achieve the desired contour. Once the ideal lid shape is confirmed, the sutures are permanently tied with small knots that are buried at each end. After the removal of the temporary traction sutures, the incision on the lid crease skin is closed. In cases where a modified or sutureless Fasanella-Servat repair is performed, hemostat forceps are utilized to grasp the tarsoconjunctival Muller complex along the marked lines, remaining in place for 60 seconds. Upon removal of the hemostat, a broad ischemic groove of tissue is left behind, which is subsequently excised. This technique eliminates the need for suture repair, as the compressed groove at the site of the forceps functions as a mechanical suture, effectively securing the eyelid in its new position.