67924

👁️ CPT 67924 — Repair of Entropion; Extensive (Tarsal Strip or Capsulopalpebral Fascia Repairs Operation)

Quick Reference

wRVU: 5.13 | Global Period: 090 (90 days) | Assistant Payable: ❌ No | Bilateral Indicator: 1

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📋 Clinical Description

CPT 67924 describes an extensive surgical repair of entropion, addressing the underlying structural laxity or scarring that causes the eyelid margin to roll inward against the globe. This code captures two predominant techniques: (1) the lateral tarsal strip (LTS) procedure, in which the lateral tarsus is exposed, a strip of tarsus is fashioned and secured to the orbital rim periosteum via canthopexy to tighten horizontal laxity; and (2) capsulopalpebral fascia repair, in which the retractor complex is reattached to the inferior tarsal border to correct involutional lower lid changes. This is the most extensive level in the entropion repair family and is selected over 67921 (suture repair only) and 67923 (excision of tarsal wedge) when horizontal eyelid laxity, retractor disinsertion, or cicatricial changes require structural reconstruction rather than simple repositioning.

Entropion is an inward rolling of the eyelid margin, most commonly the lower lid, causing the lashes and lid skin to chronically abrade the corneal and conjunctival epithelium; if untreated, this leads to corneal ulceration, pannus formation, and potentially vision-threatening scarring. The four major subtypes — involutional/senile, cicatricial, mechanical, and spastic — each carry distinct ICD-10-CM code axes and may require different operative approaches. When cicatricial entropion results from a documented infectious etiology such as trachoma, the sequela code B94.0 should accompany the eyelid diagnosis code to support medical necessity.

This procedure may be performed in the following clinical contexts:

• Involutional (Senile) Entropion with Horizontal Laxity — The most common indication; age-related horizontal lid laxity and capsulopalpebral fascia disinsertion combine to cause medial or diffuse entropion, requiring the lateral tarsal strip ± retractor reattachment to restore lid position.
• Cicatricial Entropion from Scarring — Posterior lamellar scarring from chronic inflammation (Stevens-Johnson, ocular cicatricial pemphigoid, trachoma, chemical injury) creates inward traction on the lid margin requiring mucous membrane grafting or scar release in addition to the structural repair captured by this code.
• Recurrent Entropion After Prior Suture Repair — When 67921 or 67922 fails and the lid re-inverts, an extensive procedure is indicated to address the underlying anatomic cause rather than repeat temporary correction.
• Post-Trachoma Cicatricial Entropion — Lid margin inversion following sequelae of trachoma with active trichiasis driving corneal abrasion; report B94.0 as an additional diagnosis code to document the infectious etiology and support medical necessity review.
• Combined Entropion with Significant Corneal Involvement — When entropion has caused a corneal ulcer or erosion documented separately, the corneal complication code is reported as an additional diagnosis to reflect the severity and urgency of the repair.

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🔬 Anatomical & Procedural Considerations

Technique Variant	Mechanism / Operative Steps	Key Notes / Coding Impact
Lateral Tarsal Strip (LTS)	Lateral canthotomy and inferior cantholysis are performed; a tarsal strip is fashioned from the lateral lower lid tarsus; the strip is anchored to the inner aspect of the lateral orbital rim periosteum with permanent or long-lasting absorbable suture, shortening the horizontal lid dimension	Most commonly performed technique for involutional entropion; horizontal lid tightening is the anatomic goal; the lateral canthal angle is reconstructed; document “lateral tarsal strip” explicitly in the operative note to distinguish from simpler approaches
Capsulopalpebral Fascia Repair / Retractor Reattachment	The capsulopalpebral fascia (lower lid retractors) is identified in the inferior fornix approach, the disinserted or attenuated fascia is advanced, and re-sutured to the inferior tarsal border to restore posterior lamellar tension	May be combined with LTS; operative note must specify “capsulopalpebral fascia repair” or “retractor reattachment/advancement” to support 67924 over 67921; frequently described as “CPF repair” or “involutional entropion repair via fornix approach”
Combined LTS + Quickert/Rotation Sutures	Lateral tarsal strip combined with infraciliary (Quickert) rotating sutures placed through all layers of the lid to evert the margin and reduce orbicularis override	The rotation sutures are considered part of the extensive repair when performed in the same session; not separately reportable; the operative note should document both components
Cicatricial Repair with Scar Release / Graft	Posterior lamellar scar is released; mucous membrane or hard palate graft placed to replace scarred conjunctiva and lengthen the posterior lamella; the structural correction addresses the cicatricial force	If tissue graft from a separate donor site is obtained, check payer policy for separate graft code reporting — many payers bundle it; document graft type, harvest site, and placement site

Clinical Pearl

The single most important documentation element distinguishing 67924 from 67921 (suture repair) is the operative note’s explicit naming of the technique: the note must contain the words “lateral tarsal strip,” “capsulopalpebral fascia repair,” “retractor reattachment,” or comparable structural repair language. An operative note that only documents rotating or everting sutures without structural lid tightening will support at most 67921, and payers will downcode accordingly. The NCCI does not bundle 67924 with a same-session E/M when modifier -25 is appropriately appended to the E/M code and the documentation supports a separately identifiable visit.

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✅ Procedure Includes

• Pre-procedure slit-lamp or external examination and laterality confirmation bundled into the 90-day global
• Local infiltration anesthesia (monitored anesthesia care or general anesthesia billed separately by the anesthesiologist if used in ASC/hospital setting)
• Lateral canthotomy and cantholysis (when LTS approach performed) — included; not separately reportable
• Fashioning of the tarsal strip and canthopexy suture placement to orbital rim periosteum
• Capsulopalpebral fascia identification, mobilization, advancement, and suture fixation to the inferior tarsus (when performed)
• Reconstruction of the lateral canthal angle and skin closure
• Intraoperative assessment of lid position, margin eversion, and canthal angle symmetry
• Application of antibiotic ophthalmic ointment and sterile dressing at the conclusion of the procedure
• Documentation of laterality, specific technique performed, structures repaired, and suture materials used

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❌ Excludes / Do Not Report Together

Code	Description	Relationship to 67924
67921	Repair of entropion; suture	Mutually exclusive with 67924 at the same site and session — suture repair only is the simpler approach; if an extensive structural repair is performed, 67924 is the correct code and 67921 is not separately reportable; select the code that matches the documented technique
67922	Repair of entropion; thermocauterization	Mutually exclusive at same site same session; thermocauterization alone does not rise to the level of an extensive repair; do not report 67922 with 67924 at the same eyelid in the same operative session
67923	Repair of entropion; excision tarsal wedge	Mutually exclusive at same site same session; when a tarsal wedge excision is performed as part of a more extensive repair that also includes structural components meeting 67924 criteria, report only 67924
67917	Repair of ectropion; extensive (eg, tarsal strip operations)	The ectropion-equivalent of 67924 — do not confuse or co-report for the same eyelid; 67917 is selected when the eyelid turns outward; 67924 is selected when it turns inward; bilateral lower lid procedures for simultaneous entropion and ectropion on different lids use separate codes with appropriate laterality modifiers
E/M codes (992xx / 920xx)	Office visit, any level	Separately reportable only when modifier -25 is appended to the E/M code (not to 67924), documenting a significant, separately identifiable evaluation and management service beyond the routine pre-procedure assessment on the same date

Bundling Alert — Global Period is 090, Not 000 or 010

CPT 67924 carries a 90-day global period — all follow-up care related to the entropion repair, including wound checks, suture removal, and lid position reassessment, is bundled into the procedure payment from the day of surgery through postoperative day 90. The most common audit finding is billing separate E/M visits within the 90-day window without modifier -24 (unrelated E/M) or without documentation confirming the visit is for an entirely unrelated condition. Modifier -24 must be appended to the E/M code (not to 67924) and the note must explicitly state the reason for the visit is unrelated to the entropion repair. The closest sibling code, 67921 (suture repair), carries the same 090 global period, so the global window does not change with technique selection — but the wRVU (and thus the payment) is significantly higher for 67924.

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🌳 Code Tree — Surgery: Eyelids — Repair (Brow Ptosis, Blepharoptosis, Lid Retraction, Ectropion, Entropion)

CPT 67900-67924 Surgery: Eyelids — Repair Procedures  
│  
├── 67900 Repair of brow ptosis (supraciliary, mid-forehead or coronal approach) (Global: 090)  
│  
├── 67901-67908 Repair of Blepharoptosis  
│ ├── 67901 Frontalis muscle technique with suture or other material (Global: 090)  
│ ├── 67902 Frontalis muscle technique with autologous fascial sling (Global: 090)  
│ ├── 67903 (Tarso) levator resection or advancement, internal approach (Global: 090)  
│ ├── 67904 (Tarso) levator resection or advancement, external approach (Global: 090)  
│ ├── 67906 Superior rectus technique with fascial sling (Global: 090)  
│ └── 67908 Conjunctivo-tarso-Muller's muscle-levator resection (Global: 090)  
│  
├── 67909 Reduction of overcorrection of ptosis (Global: 090)  
│  
├── 67911 Correction of lid retraction (Global: 090)  
│  
├── 67912 Correction of lagophthalmos, with implantation of upper eyelid lid load (Global: 090)  
│  
├── 67914-67917 Repair of Ectropion  
│ ├── 67914 Repair of ectropion; suture (Global: 090)  
│ ├── 67915 Repair of ectropion; thermocauterization (Global: 090)  
│ ├── 67916 Repair of ectropion; excision tarsal wedge (Global: 090)  
│ └── 67917 Repair of ectropion; extensive (eg, tarsal strip operations) (Global: 090)  
│  
└── 67921-67924 Repair of Entropion  
├── 67921 Repair of entropion; suture (Global: 090)  
├── 67922 Repair of entropion; thermocauterization (Global: 090)  
├── 67923 Repair of entropion; excision tarsal wedge (Global: 090)  
└── ▶▶ 67924 ◀◀ Repair of entropion; extensive (eg, tarsal strip or capsulopalpebral fascia repairs operation) ← YOU ARE HERE (Global: 090)

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💰 RVU & Reimbursement Profile

Component	Value
Work RVU (wRVU)	5.13 (2026 CMS MPFS — reflects -2.5% efficiency adjustment applied to CY2026 fee schedule; verify against RVU26A file for final value)
Global Period	090 (90 days)
Bilateral Indicator	1 — Subject to standard bilateral reduction rules; when performed bilaterally in the same session, Medicare pays 150% of the single-procedure allowable (100% first side + 50% second side)
Assistant Surgeon	❌ Not payable
Co-Surgeon	❌ Not applicable
Team Surgery	❌ Not applicable
PC/TC Split	❌ No — procedure code only (Indicator 0)
Modifier -51 Exempt	No
Anesthesia	Local infiltration anesthesia is the standard for office-based repair; monitored anesthesia care (MAC) or general anesthesia is separately billed by the anesthesiologist when performed in ASC or hospital outpatient setting

Bilateral Billing Rules

67924 has a bilateral indicator of 1, meaning it is subject to Medicare’s standard bilateral reduction rule. When performed on both lower eyelids (or an upper and lower eyelid on opposite sides) in the same operative session, the preferred billing format is a single line item with modifier -50 for most MACs, though some MACs prefer two separate lines with -RT and -LT modifiers (or E-modifiers for eyelid specificity). Medicare pays 150% of the single-procedure allowable — 100% for the first side and 50% for the second side. Private payers vary; verify bilateral payment policy with each payer. When submitting two separate lines, the second line should carry modifier -51 on the lower-valued unit.

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🏷️ Modifier Reference

Modifier	Name	When to Apply
-RT	Right Side	Procedure performed on the right eyelid (upper or lower); use in conjunction with E-modifier for maximum specificity
-LT	Left Side	Procedure performed on the left eyelid; pair with E-modifier for eyelid-level specificity
-50	Bilateral Procedure	Both eyelids repaired in the same session; report as single line with -50 per most MAC preferences; confirm individual MAC format
-E1	Upper Left Eyelid	Entropion repair of the upper left eyelid specifically
-E2	Lower Left Eyelid	Entropion repair of the lower left eyelid — most common site for involutional entropion
-E3	Upper Right Eyelid	Entropion repair of the upper right eyelid
-E4	Lower Right Eyelid	Entropion repair of the lower right eyelid
-25	Significant, Separately Identifiable E/M	Applied to the E/M code — not 67924 — when an office visit is performed on the same date as the procedure; documentation must support a medically necessary evaluation and management service distinct from the routine pre-procedure assessment
-24	Unrelated E/M During Postoperative Period	Applied to the E/M code when the patient is seen within the 90-day global window for a condition wholly unrelated to the entropion repair; the note must document the unrelated nature of the visit explicitly
-51	Multiple Procedures	When 67924 is performed alongside other surgical procedures in the same session; apply to the lower-valued procedure code
-59	Distinct Procedural Service	When payers inappropriately bundle 67924 with another eyelid procedure; documents a separate anatomic site, distinct eyelid, or independent operative service
-52	Reduced Services	Procedure partially completed; document clinical reason for reduction in the operative note
-53	Discontinued Procedure	Procedure stopped after anesthesia initiation due to patient safety concern; thorough documentation required
-58	Staged or Related Procedure	Planned staged procedure during the 90-day global period (e.g., second-stage grafting planned at time of initial repair)
-78	Unplanned Return to OR	Unplanned return to the operating room for a complication arising within the 90-day global period
-79	Unrelated Procedure During Postoperative Period	Unrelated surgical procedure performed during the 90-day global window; not related to the entropion repair

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🩺 Common ICD-10-CM Pairings

Senile / Involutional Entropion

ICD-10 Code	Description	HCC?	Clinical Notes
H02.031	Senile entropion of right upper eyelid	❌ No	Use when age-related horizontal laxity and retractor disinsertion drive upper eyelid inversion on the right; confirm “senile” or “involutional” is documented
H02.032	Senile entropion of right lower eyelid	❌ No	Most common involutional entropion site; document right lower lid explicitly
H02.034	Senile entropion of left upper eyelid	❌ No	Left upper lid; confirm provider has documented laterality — upper vs. lower distinction is required
H02.035	Senile entropion of left lower eyelid	❌ No	Most common presentation; left lower eyelid involutional entropion
H02.033	Senile entropion of right eye, unspecified eyelid	❌ No	Use only when provider documents right eye but does not specify upper or lower; query for eyelid-level specificity when possible
H02.036	Senile entropion of left eye, unspecified eyelid	❌ No	Use only when laterality is right or left but upper/lower is not documented; query provider

Cicatricial Entropion

ICD-10 Code	Description	HCC?	Clinical Notes
H02.011	Cicatricial entropion of right upper eyelid	❌ No	Scarring-driven entropion, right upper lid; common in trachoma, Stevens-Johnson, pemphigoid — add etiology code when documented
H02.012	Cicatricial entropion of right lower eyelid	❌ No	Right lower lid cicatricial; often requires posterior lamellar graft in addition to structural repair
H02.014	Cicatricial entropion of left upper eyelid	❌ No	Left upper; confirm upper vs. lower distinction in documentation before assigning
H02.015	Cicatricial entropion of left lower eyelid	❌ No	Left lower cicatricial entropion

Mechanical Entropion

ICD-10 Code	Description	HCC?	Clinical Notes
H02.021	Mechanical entropion of right upper eyelid	❌ No	Caused by mass effect or ocular prosthesis — document the underlying mechanical cause as secondary diagnosis
H02.022	Mechanical entropion of right lower eyelid	❌ No	Right lower lid; ensure the mechanical cause is separately documented
H02.024	Mechanical entropion of left upper eyelid	❌ No	Left upper lid; mechanical cause must be documented by provider
H02.025	Mechanical entropion of left lower eyelid	❌ No	Left lower lid

Spastic Entropion

ICD-10 Code	Description	HCC?	Clinical Notes
H02.041	Spastic entropion of right upper eyelid	❌ No	Orbicularis spasm driving inversion; consider whether this truly requires extensive repair vs. suture correction — document medical necessity for 67924 level
H02.042	Spastic entropion of right lower eyelid	❌ No	Right lower spastic; verify provider documents spastic vs. involutional etiology
H02.044	Spastic entropion of left upper eyelid	❌ No	Left upper; confirm documentation
H02.045	Spastic entropion of left lower eyelid	❌ No	Left lower spastic entropion

Underlying Etiology / Complication Codes

ICD-10 Code	Description	HCC?	Clinical Notes
B94.0	Sequelae of trachoma	❌ No	Report as additional diagnosis when cicatricial entropion is a documented late effect of prior trachoma infection; supports medical necessity and payer review narrative
H16.001	Unspecified corneal ulcer, right eye	❌ No	Report when provider separately and explicitly documents corneal ulceration as a complication of chronic entropion and lash-corneal contact; report the laterality-specific code matching the operative eye
H16.011	Central corneal ulcer, right eye	❌ No	When central corneal ulcer is specifically documented as a complication; report only with explicit provider documentation — do not infer
H02.801	Unspecified disorder of right upper eyelid	❌ No	Use only as a last resort when entropion subtype is entirely undocumented; always attempt to query provider for subtype specificity before defaulting

Coding Specificity Reminder

The ICD-10-CM entropion codes require three axes of specificity: (1) subtype — cicatricial, mechanical, senile, or spastic; (2) laterality — right vs. left; and (3) eyelid — upper vs. lower. The single most commonly missed axis in oculoplastic coding is upper vs. lower — coders who stop at right or left and assign the “unspecified eyelid” code are leaving documentation on the table. Query the provider using your facility’s CDI query policy whenever the operative note identifies the eye but not the specific lid. ICD-10-CM specificity requirements are not optional — an unspecified code that should have been specific is a documentation deficiency, not a compliant coding choice.

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🏥 MS-DRG Considerations (Inpatient)

Inpatient Coding Reminder

CPT 67924 is performed primarily in the outpatient or ASC setting. There are no routine MS-DRG assignments for this procedure — inpatient admission solely for entropion repair would not be supported by any payer, MAC, or utilization review body under standard criteria. If a patient undergoing inpatient admission for an unrelated diagnosis (e.g., post-surgical recovery from a different procedure) also has entropion repaired, an ICD-10-PCS code may be assigned for completeness, but it will have no meaningful impact on DRG grouping. See the ICD-10-PCS section below.

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🔧 ICD-10-PCS Equivalents (Inpatient Facility Coding)

Note

Inpatient PCS coding for eyelid entropion repair is encountered rarely and almost exclusively when the procedure is incidentally performed during an inpatient stay for an unrelated condition. The PCS root operation for entropion repair is most commonly Repair (Q) — restoring the body part to its normal anatomic structure and function — rather than Reposition (S), as the structural correction involves tissue manipulation and suture fixation rather than simply moving an already-intact body part. Assign separate PCS code lines for each eyelid repaired; PCS has no bilateral modifier equivalent.

PCS Code	Full Description	Applicable Modality
08Q53ZZ	Repair, Upper Eyelid, Right, Percutaneous Approach, No Device, No Qualifier	Lateral tarsal strip or structural repair, right upper eyelid
08Q63ZZ	Repair, Lower Eyelid, Right, Percutaneous Approach, No Device, No Qualifier	Lateral tarsal strip or capsulopalpebral fascia repair, right lower eyelid (most common)
08Q73ZZ	Repair, Upper Eyelid, Left, Percutaneous Approach, No Device, No Qualifier	Structural repair, left upper eyelid
08Q83ZZ	Repair, Lower Eyelid, Left, Percutaneous Approach, No Device, No Qualifier	Lateral tarsal strip or capsulopalpebral fascia repair, left lower eyelid

PCS Character Analysis — 08Q63ZZ

Position	Character	Value	Definition
1	Section	0	Medical and Surgical
2	Body System	8	Eye
3	Root Operation	Q	Repair (restoring, to the extent possible, a body part to its normal anatomic structure and function)
4	Body Part	6	Lower Eyelid, Right
5	Approach	3	Percutaneous
6	Device	Z	No Device
7	Qualifier	Z	No Qualifier

PCS Root Operation: Repair (Q) vs. Reposition (S)

• Use Repair (Q) when the surgical goal is restoration of structural integrity of the eyelid — sutures, fascial repair, tarsal strip anchoring — as the dominant operative action; this is the correct root operation for the vast majority of 67924-equivalent inpatient cases
• Use Reposition (S) only when the operative documentation supports that the primary action is moving a body part to its normal or other suitable location without resection or repair of the tissue itself — rare in the context of entropion repair
• When both the upper and lower lids on the same eye are repaired in the same operative session, assign separate PCS code lines — PCS does not allow a single code to capture bilateral or multi-structure procedures with one code line

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📝 Coding Examples

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Example 1 — ASC: Right Lower Lid Involutional Entropion, Lateral Tarsal Strip

Clinical Scenario: A 74-year-old male with a 2-year history of right lower eyelid entropion presents for surgical correction. Examination reveals right lower lid inversion with lash-corneal contact, epiphora, and positive lid distraction test indicating significant horizontal laxity. The surgeon performs a lateral canthotomy, inferior cantholysis, and fashions a tarsal strip from the right lower lateral tarsus, which is secured to the inner aspect of the right lateral orbital rim periosteum with 4-0 Mersilene suture. The lateral canthal angle is reconstructed and skin closed with 6-0 fast-absorbing suture. Operative note states: “Lateral tarsal strip procedure performed for correction of right lower lid involutional entropion.” No separate E/M service was performed on this date.

Field	Code	Rationale
CPT	67924-E4	Extensive entropion repair; E4 modifier specifies right lower eyelid; operative note explicitly documents “lateral tarsal strip procedure”
PDx	H02.032	Senile entropion of right lower eyelid — most specific code matching documented subtype (involutional = senile in ICD-10-CM), laterality, and eyelid level

Note

No modifier -25 is applicable here because no separate E/M was performed on the date of service. The pre-procedure examination is bundled into the 90-day global period that begins on the operative date. The 90-day global clock starts on 05/23/2026 in this scenario — all follow-up visits through 08/21/2026 are bundled unless modifier -24 and unrelated documentation support separate billing.

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Example 2 — ASC: Bilateral Lower Lid Entropion with Same-Day Pre-Op E/M

Clinical Scenario: A 79-year-old female presents for repair of bilateral lower eyelid senile entropion with documented horizontal laxity bilaterally. At the same visit, the surgeon performs a significant pre-operative evaluation addressing new-onset ocular surface disease and adjusts her dry eye treatment regimen — this evaluation is separately documented as a distinct medical decision-making encounter. The surgeon then performs lateral tarsal strip procedures bilaterally. Operative note documents: “Bilateral lower eyelid lateral tarsal strip procedures performed for correction of bilateral involutional entropion with horizontal laxity.”

Field	Code	Rationale
CPT 1	92014-25	Comprehensive ophthalmological exam, established patient — modifier -25 appended to the E/M (NOT to 67924) to document the separately identifiable service addressing ocular surface disease
CPT 2	67924-E2	Extensive entropion repair, left lower eyelid
CPT 3	67924-E4-51	Extensive entropion repair, right lower eyelid; modifier -51 on the second (lower-valued) procedure line
PDx	H02.035	Senile entropion of left lower eyelid — primary diagnosis
SDx	H02.032	Senile entropion of right lower eyelid — secondary diagnosis, second operative site

Warning

Modifier -25 belongs on the E/M code (92014), NOT on CPT 67924. A common compliance error is appending -25 to the procedure code — this is incorrect and will cause a claim edit or audit flag. The E/M documentation must demonstrate medical decision-making or history/exam elements that go beyond the routine pre-procedure evaluation; documenting only “patient presents for surgery today” is insufficient to support a separately billable E/M service.

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Example 3 — Office: Cicatricial Entropion, Left Upper Eyelid, Post-Trachoma Sequelae

Clinical Scenario: A 68-year-old female with documented history of prior trachoma infection presents with left upper eyelid cicatricial entropion causing chronic lash-corneal abrasion and inferior corneal scarring. The surgeon performs repair of the left upper eyelid cicatricial entropion via scar release and posterior lamellar lengthening with a buccal mucous membrane graft combined with a tarsal strip procedure. The operative note documents: “Left upper eyelid cicatricial entropion repair; posterior lamellar scar release with mucous membrane graft placement and lateral tarsal strip.” The patient returns at postoperative week 2 for a wound check — no separate issues noted, visit bundled into global.

Field	Code	Rationale
CPT 1	67924-E1	Extensive entropion repair, left upper eyelid (E1 = upper left); operative note documents tarsal strip + scar release meeting extensive repair criteria
PDx	H02.014	Cicatricial entropion of left upper eyelid — most specific code; subtype (cicatricial), laterality (left), and eyelid level (upper) all documented
SDx	B94.0	Sequelae of trachoma — additional diagnosis supporting the cicatricial etiology; documents the historical infectious cause and supports medical necessity for the complex repair

Note

Global period reminder: The 90-day global period begins on the date of this procedure. The week-2 wound check is entirely bundled into the 67924 payment — no separate E/M may be billed for that visit. If the patient presents during the 90-day window for an unrelated condition (e.g., a new retinal complaint), the separate E/M should be billed with modifier -24 on the E/M code, and the documentation must explicitly state the visit is unrelated to the entropion repair.

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⚠️ Common Coding Pitfalls

• Missing Technique Documentation in the Operative Note: The most common audit finding for 67924 is an operative note that describes rotating sutures or everting sutures without using the words “lateral tarsal strip,” “capsulopalpebral fascia repair,” or “retractor reattachment.” Without these specific terms, the claim will be downcoded to 67921 (suture repair only), which carries a significantly lower wRVU and payment. The operative note must name the structural procedure performed — a vague note saying “entropion repair performed” is insufficient to defend 67924 on audit.

• Incorrect Global Period Application: Some billers confuse the 90-day global for 67924 with a 10-day global (applicable to minor procedures). All services related to the entropion repair — wound checks, lid position evaluations, suture removal, minor complications — are bundled for the full 90-day window. Billing a separate E/M within that window without modifier -24 and unrelated documentation creates an overpayment liability and recoupment exposure.

• Billing -25 on the Wrong Code: Modifier -25 must be appended to the E/M code, not to CPT 67924. Placing -25 on the procedure code is a coding error that triggers automated claim edits and may flag the account for audit. The E/M documentation must independently support a medically necessary evaluation beyond the pre-procedure assessment — a note that only documents pre-op preparation for the same-day procedure will not survive scrutiny.

• Reporting 67924 and a Sibling Entropion Code for the Same Eyelid Same Session: CPT codes 67921, 67922, 67923, and 67924 are mutually exclusive for the same eyelid at the same session. If the surgeon performs multiple entropion repair techniques on the same lid (e.g., sutures plus a tarsal strip), only the most extensive code (67924) is reportable. Reporting 67921 alongside 67924 for the same lid will be denied as a duplicate/bundled service.

• Defaulting to Unspecified Entropion Without Querying for Subtype: The ICD-10-CM entropion code family requires subtype specificity (cicatricial, mechanical, senile, spastic). Defaulting to an unspecified or parent code because the note is unclear — without querying the provider — is a documentation deficiency. Identify the subtype in the operative report or clinic note, and when absent, initiate a physician query per your facility’s CDI policy before assigning an unspecified code.

• Failing to Track the 90-Day Global Window in the Practice Management System: Without a systematic flag in your PM/EHR system marking 67924 procedure dates and blocking same-surgeon E/M claims within the 90-day window, revenue cycle teams can inadvertently bill and receive overpayments for bundled post-op visits. The financial consequence is recoupment, interest, and potential False Claims Act exposure if the pattern is widespread. Flag the procedure date, set a 90-day reminder, and require modifier -24 plus clinical review before releasing any E/M claim within the global window.

• Incorrect E-Modifier Selection for Eyelid Level: A common specificity gap in oculoplastic billing is using only RT/LT without the eyelid-specific E-modifiers. When entropion is repaired on the lower eyelid (the most common site), -E2 (lower left) or -E4 (lower right) should accompany the laterality modifier to provide maximum claim specificity and prevent confusion when bilateral eyelid procedures are performed at the same session.

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📎 Sources

¹ AMA CPT 2025-2026 Professional Edition — Surgery: Eyelids, code 67924 and family 67921-67924

² CMS 2026 Medicare Physician Fee Schedule Final Rule (CMS-1832-F), published October 31, 2025 — Efficiency adjustment of -2.5% applied to wRVU values; conversion factors $33.5675(QP)/$33.4009 (non-QP)

³ CMS RVU26A Relative Value Files — 67924 wRVU value; verify final value in Addendum B of the RVU26A file

⁴ NCCI Policy Manual for Medicare Services, Chapter 3 (Surgery), CMS 2025-2026 — Bundling relationships within the entropion repair code family

⁵ ICD-10-CM Official Guidelines for Coding and Reporting FY2026 — Chapter 7 (Diseases of the Eye and Adnexa); specificity requirements for H02.0x code family

⁶ ICD-10-PCS Official Guidelines for Coding and Reporting FY2026 — Section B3.5 (Overlapping Body Layers); Root Operation definitions: Repair (Q), Reposition (S)

⁷ Aetna Clinical Policy Bulletin #0084 — Eyelid Surgery: Coverage criteria for entropion repair including 67924; medical necessity indications including symptomatic keratitis, trichiasis, cicatricial lid malposition

⁸ Home State Health / Envolve Vision Clinical Policy OC.UM.CP.0025 — Ectropion and Entropion Repair: Covered indications and CPT code references for 67921-67924

⁹ AAPC Codify — CPT 67924 code descriptor and range reference: Repair (Brow Ptosis, Blepharoptosis, Lid Retraction, Ectropion, Entropion) Procedures on the Eyelids, 67900-67924

¹⁰ Journal of Visualized Surgery (JOMI) — “Lateral Tarsal Strip Procedure for Left Lower Eyelid Entropion,” December 2023 — Procedural technique reference for LTS operative steps and anatomic goals

¹¹ Eye Rounds / University of Iowa — “Repair of Cicatricial Entropion with Quickert Sutures, Tarsal Fracture, and Lateral Tarsal Strip” — Operative technique reference for combined cicatricial repair approach