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67930

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🩺 CPT 67930 — Suture of Recent Wound, Eyelid, Involving Lid Margin, Tarsus, and/or Palpebral Conjunctiva; Not Involving One-Fourth of Lid Margin

Code Description

CPT 67930 describes the suture repair of a recent, full-thickness eyelid wound that involves one or more of the following anatomic structures: the lid margin, the tarsal plate (tarsus), and/or the palpebral conjunctiva — with the critical limitation that the wound encompasses one-fourth or less (25% or less) of the total horizontal lid margin length. This code is used for relatively smaller but still anatomically complex eyelid lacerations that require precise, layered reconstruction of the eyelid’s functional and structural components.

The full CPT descriptor reads: Suture of recent wound, eyelid, involving lid margin, tarsus, and/or palpebral conjunctiva; not involving one-fourth of lid margin, full thickness.

The word “recent” in the descriptor is clinically meaningful. It distinguishes this code from eyelid reconstructive procedures performed for old, chronic, or staged defects. A “recent wound” generally refers to an acute traumatic laceration presenting within hours to days of injury that is still amenable to primary repair by direct suture closure. Wounds presenting beyond 24-48 hours may require clinical judgment regarding primary vs. delayed primary vs. secondary closure depending on contamination, tissue viability, and edema.

The “not involving one-fourth of lid margin” threshold is the single most important distinction between CPT 67930 and CPT 67935. A defect involving 25% or less of the lid margin can typically be repaired by direct layered suture closure without requiring adjunctive reconstructive flaps or grafts. In most patients, the average lower eyelid horizontal span is approximately 26-30 mm, making one-fourth approximately 6.5-7.5 mm. A defect of 6-7 mm or less of the lower lid margin, when tissue edges are approximable without undue tension, is appropriate for CPT 67930.

Despite being classified as a “smaller” eyelid wound compared to the 67935 threshold, full-thickness eyelid lacerations involving the lid margin, tarsus, and/or palpebral conjunctiva are technically demanding repairs. The eyelid margin must be reconstructed with millimeter-level precision to prevent post-operative complications including trichiasis (misdirected eyelashes contacting the cornea), lid notching, entropion, ectropion, lagophthalmos, and corneal exposure. A technically poor lid margin repair — even of a small wound — can result in permanent eyelid deformity and corneal injury.

Anatomic Context

Understanding eyelid anatomy is essential for correct code assignment in eyelid wound repairs. Full-thickness eyelid involvement — the defining feature of the 67930/67935 code family — means the wound traverses all layers from anterior skin to posterior palpebral conjunctiva.

Anterior Lamella

  • Eyelid skin — among the thinnest skin in the body (0.5-1.0 mm); highly elastic and mobile, with minimal subcutaneous fat in the pretarsal region
  • Orbicularis oculi muscle — the circumferential striated muscle controlling eyelid closure; divided into orbital, preseptal, and pretarsal portions; contributes to lacrimal pump function with blinking

Posterior Lamella

  • Tarsus (tarsal plate) — a dense, fibrous connective tissue structure that gives the eyelid its structural rigidity and shape; the upper tarsus measures approximately 8-12 mm in vertical height; the lower tarsus measures approximately 3-5 mm; the tarsal plates contain the meibomian glands (modified sebaceous glands running vertically through the tarsus that secrete the lipid layer of the tear film)
  • Palpebral conjunctiva — the mucous membrane that lines the inner (posterior) surface of the eyelid; tightly adherent to the tarsal plate in the pretarsal zone; forms the fornix at its reflection onto the globe; provides a smooth, lubricated surface against the cornea and bulbar conjunctiva with each blink

Lid Margin — The Critical Landmark

  • The free edge of the eyelid where the anterior and posterior lamellae converge
  • Gray line (intermarginal sulcus) — a subtle gray-appearing linear landmark visible at the lid margin corresponding to the plane between the anterior and posterior lamellae and the location of the muscle of Riolan; the gray line is the surgical plane used to split the anterior from the posterior lamella during lid-splitting procedures and is the reference point for the most important suture placed during lid margin repair
  • Meibomian gland orifices — approximately 20-30 orifices visible at the posterior lid margin, just anterior to the mucocutaneous junction
  • Eyelashes (cilia) and their follicles — located in the anterior portion of the lid margin; follicle injury can cause permanent lash loss or aberrant lash growth (trichiasis)
  • Punctum lacrimale — the lacrimal drainage ostium located at the medial lid margin; the upper and lower puncta drain tears into the canaliculi; punctal involvement in medial lid lacerations must always be assessed

Operative Overview

Pre-operative Assessment

Before proceeding to operative repair, the following must be assessed:

  • Extent of lid margin involvement — measure the horizontal extent of the laceration in millimeters and estimate as a percentage of total lid width; this determines the correct CPT code (67930 vs. 67935)
  • Full-thickness vs. partial-thickness — confirm that the wound traverses all layers; partial-thickness wounds not involving the lid margin are reported with wound repair codes, not eyelid-specific codes
  • Canalicular involvement — medial lid lacerations within 6-8 mm of the medial canthus must be assessed for canalicular laceration using dilation and irrigation; if canalicular injury is present, separate canalicular repair (CPT 68700) is required and is separately reportable
  • Globe integrity — always examine the globe for scleral laceration, corneal laceration, or penetrating injury before manipulating the eyelid
  • Foreign body — rule out retained foreign body in the wound or orbit with appropriate imaging (CT orbits) if the mechanism suggests high-velocity or sharp penetrating trauma
  • Levator function — assess for ptosis suggesting levator injury, which may require separate repair
  • Canthal tendon integrity — palpate for medial and lateral canthal tendon avulsion, particularly in traumatic lid margin lacerations extending to the canthal regions

Surgical Technique — Direct Layered Closure for Lid Margin Wound

The definitive technique for primary repair of a full-thickness lid margin laceration involves precise, anatomically layered closure proceeding from posterior to anterior:

Step 1 — Posterior Lamellar Repair (Tarsus and Palpebral Conjunctiva) The palpebral conjunctiva and tarsal plate are reapproximated using fine absorbable sutures (typically 5-0 or 6-0 polyglactin 910, Vicryl). Sutures are placed in a partial-thickness fashion through the tarsus, ensuring they do not penetrate the full thickness of the tarsus and expose suture material on the conjunctival surface — exposed suture against the cornea causes corneal abrasion. Bites are taken in a vertical mattress fashion to adequately coapt the tarsal edges.

Step 2 — Lid Margin Repair (The Critical Step) Three key sutures are placed at the lid margin to ensure precise anatomical reapproximation and prevent lid notching:

  • First suture at the gray line — a 5-0 or 6-0 silk or nylon suture is placed at the gray line on both sides of the wound and tied, with the suture tails left long (approximately 10-15 mm) to be incorporated into the skin closure; this is the alignment suture that re-establishes the anatomic continuity of the intermarginal sulcus
  • Second suture at the meibomian orifice line (posterior lash line) — placed just anterior to the meibomian gland orifices on both sides; this reapproximates the posterior lid margin
  • Third suture at the anterior lash line — placed at the level of the eyelash follicles; this reapproximates the anterior lid margin

The long tails of the margin sutures are incorporated into the skin closure to prevent the suture knots from rubbing against the cornea. Silk sutures are traditionally used at the lid margin because they are soft, pliable, and well-tolerated; they are removed at 7-10 days post-operatively.

Step 3 — Anterior Lamellar Repair (Orbicularis and Skin) The orbicularis oculi muscle is reapproximated with interrupted absorbable sutures (5-0 or 6-0 polyglactin) to eliminate dead space and restore the muscular layer. The eyelid skin is closed with interrupted or running fine non-absorbable sutures (6-0 nylon or polypropylene), or with absorbable sutures in pediatric patients to avoid suture removal under sedation.

The long tails of the lid margin silk sutures are incorporated into the skin closure by laying them along the skin surface and securing them under the skin sutures — this prevents the suture knots from touching the corneal surface during the healing period.

Includes

  • Suture repair of a full-thickness eyelid wound involving one or more of: lid margin, tarsus, and/or palpebral conjunctiva, when the defect is 25% or less of the total horizontal lid margin
  • Layered closure of the posterior lamella (palpebral conjunctiva and tarsus)
  • Precise anatomic reapproximation of the lid margin at the gray line, meibomian orifice line, and lash line
  • Layered closure of the anterior lamella (orbicularis oculi and eyelid skin)
  • Local anesthetic injection for operative field anesthesia
  • Pre- and post-operative examination services within the global period (90 days)
  • Removal of sutures within the global period

Excludes / Report Separately

  • Repair involving more than one-fourth of the lid margin — report CPT 67935 instead; 67930 is only appropriate when the defect is 25% or less of the total lid margin
  • Eyelid skin laceration NOT involving the lid margin, tarsus, or palpebral conjunctiva — these are partial-thickness eyelid wounds reported with standard wound repair codes:
    • CPT 12011-12018 — Simple repair, face/ears/eyelids/nose/lips (by length)
    • CPT 12031-12037 — Intermediate repair, face (by length)
    • CPT 13150-13153 — Complex repair, eyelids, nose, ears, lips (by length)
    • Selection depends on wound complexity (simple vs. layered repair) and total wound length
  • Canalicular laceration repair — CPT 68700 (plastic repair of canaliculi); when a medial eyelid laceration involves the canalicular system and formal intubation with silicone stent is performed, 68700 is separately reportable with documentation of canalicular involvement and intubation technique; this is NOT bundled into 67930
  • Excision and repair of eyelid (post-tumor excision) — when the defect results from deliberate surgical excision (e.g., after Mohs surgery for eyelid basal cell carcinoma), the correct code family is 67961 (not involving one-fourth of lid margin) or 67966 (over one-fourth of lid margin), not 67930/67935; the 67961/67966 series captures both excision and repair
  • Levator repair for ptosis — CPT 67901-67908 depending on technique; separately reportable if levator injury is identified and repaired at the same session; requires separate documentation of levator involvement and specific repair technique
  • Blepharoplasty — functional or cosmetic (CPT 15820-15823 or 67900-67904); separately reportable when performed at a distinct site on the eyelid for a distinct indication
  • Orbital floor or wall repair — CPT 21385-21395; separately reportable if performed at the same session for orbital blowout fracture associated with periorbital trauma
  • Repair of lacrimal punctum — CPT 68440 (snip operation, punctum); separately reportable if the punctum requires formal repair
  • Conjunctivoplasty — CPT 68320-68335; separately reportable if extensive conjunctival repair beyond the palpebral conjunctiva is performed as a distinct procedure
  • Tarsorhaphia (temporary tarsorrhaphy) — CPT 67875; if a temporary tarsorrhaphy is placed at a separate site to protect the cornea while the primary wound heals, this may be separately reportable
  • Foreign body removal from eyelid — CPT 67938 (removal of embedded foreign body, eyelid); separately reportable if a retained foreign body requires formal operative removal as a distinct component of the procedure
  • Skin graft for eyelid repair — if a formal skin graft from a distant donor site is required as part of a complex repair that exceeds primary closure, the procedure may warrant reconsideration of the code; a true skin graft from a non-adjacent site may be separately reportable with CPT 15260/15261 — review NCCI edits carefully

Code Tree — Eyelid Repair and Reconstruction CPT Codes

CPT CodeDescription
67930Suture of recent wound, eyelid, involving lid margin, tarsus, and/or palpebral conjunctiva; not involving one-fourth of lid margin — this code
67935Suture of recent wound, eyelid, involving lid margin, tarsus, and/or palpebral conjunctiva; over one-fourth of lid margin
67938Removal of embedded foreign body, eyelid
67950Canthoplasty (reconstruction of canthus)
67961Excision and repair of eyelid, involving lid margin, tarsus, conjunctiva, canthus, or full thickness; not more than one-fourth of lid margin
67966Excision and repair of eyelid, involving lid margin, tarsus, conjunctiva, canthus, or full thickness; over one-fourth of lid margin
67971Reconstruction of eyelid, full thickness by transfer of tarsoconjunctival flap from opposing eyelid; up to two-thirds of eyelid, one stage or first stage
67973Reconstruction of eyelid, full thickness by transfer of tarsoconjunctival flap from opposing eyelid; total eyelid, lower, one stage or first stage
67974Reconstruction of eyelid, full thickness by transfer of tarsoconjunctival flap from opposing eyelid; total eyelid, upper, one stage or first stage
67975Reconstruction of eyelid, full thickness by transfer of tarsoconjunctival flap from opposing eyelid; second stage
68700Plastic repair of canaliculi
68720Dacryocystorhinostomy (DCR)
68440Snip operation, punctum
12011Simple repair of superficial wounds of face, ears, eyelids, nose, lips; 2.5 cm or less
12013Simple repair of superficial wounds of face, ears, eyelids, nose, lips; 2.6-5.0 cm
13150Complex repair, eyelids, nose, ears, lips; 1.0 cm or less
13151Complex repair, eyelids, nose, ears, lips; 1.1-2.5 cm
13152Complex repair, eyelids, nose, ears, lips; 2.6-7.5 cm
67875Temporary closure of eyelids by suture (tarsorrhaphy)
67880Construction of intermarginal adhesions, median tarsorrhaphy, or canthorrhaphy

Key Distinction — 67930 vs. 67935 (Size Threshold): The single defining factor separating these two codes is the extent of lid margin involvement. CPT 67930 applies when the full-thickness wound involves 25% or less of the total horizontal lid margin length. CPT 67935 applies when it involves more than 25%. The average lower eyelid is 26-30 mm wide; 25% is approximately 6.5-7.5 mm. Measure or estimate the wound in millimeters and compare to total lid width to assign the correct code. Do not upcode to 67935 unless the wound clearly exceeds the 25% threshold.

Key Distinction — 67930 vs. 67961 (Etiology): CPT 67930 is for traumatic wounds — lacerations, bites, burns, avulsions — where the tissue disruption was unintentional and primary repair is performed. CPT 67961 is for excision and repair — where tissue is deliberately removed (such as tumor excision, Mohs defect, or excision of a lesion by the same surgeon who then reconstructs). When the same surgeon performs both the excision of a lesion and the eyelid repair in the same session, report 67961 (or 67966 if >25% of lid margin), not 67930.

Key Distinction — 67930 vs. 12011-13152 (Wound Depth / Lid Margin Involvement): Standard wound repair codes (12011-13152) are appropriate for eyelid lacerations that are partial thickness and do not involve the lid margin, tarsus, or palpebral conjunctiva. The moment a wound involves any of these three anatomic structures — lid margin, tarsus, or palpebral conjunctiva — the eyelid-specific codes (67930/67935) become appropriate, and the wound length-based codes are no longer correct. This is one of the most common eyelid coding errors seen in emergency department and urgent care billing.

ICD-10-CM Diagnosis Codes

Traumatic Eyelid Lacerations — Primary Diagnoses

ICD-10-CMDescription
S01.111ALaceration without foreign body of right eyelid and periocular area, initial encounter
S01.111DLaceration without foreign body of right eyelid and periocular area, subsequent encounter
S01.111SLaceration without foreign body of right eyelid and periocular area, sequela
S01.112ALaceration without foreign body of left eyelid and periocular area, initial encounter
S01.112DLaceration without foreign body of left eyelid and periocular area, subsequent encounter
S01.119ALaceration without foreign body of unspecified eyelid and periocular area, initial encounter
S01.121ALaceration with foreign body of right eyelid and periocular area, initial encounter
S01.122ALaceration with foreign body of left eyelid and periocular area, initial encounter
S01.129ALaceration with foreign body of unspecified eyelid and periocular area, initial encounter
S01.131APuncture wound without foreign body of right eyelid and periocular area, initial encounter
S01.132APuncture wound without foreign body of left eyelid and periocular area, initial encounter
S01.141APuncture wound with foreign body of right eyelid and periocular area, initial encounter
S01.142APuncture wound with foreign body of left eyelid and periocular area, initial encounter
S01.151AOpen bite of right eyelid and periocular area, initial encounter
S01.152AOpen bite of left eyelid and periocular area, initial encounter

Thermal and Chemical Injuries

ICD-10-CMDescription
T26.01XABurn of eyelid and periocular area, right eye, initial encounter
T26.02XABurn of eyelid and periocular area, left eye, initial encounter
T26.11XABurn of cornea and conjunctival sac, right eye, initial encounter (if corneal involvement)
T26.61XACorrosion of eyelid and periocular area, right eye, initial encounter
T26.62XACorrosion of eyelid and periocular area, left eye, initial encounter

Associated / Secondary Diagnoses

ICD-10-CMDescription
H02.811Retained foreign body in right upper eyelid
H02.812Retained foreign body in right lower eyelid
H02.814Retained foreign body in left upper eyelid
H02.815Retained foreign body in left lower eyelid
S05.31XAOcular laceration without prolapse or loss of intraocular tissue, right eye, initial encounter
S05.32XAOcular laceration without prolapse or loss of intraocular tissue, left eye, initial encounter
S02.40XAFracture of malar, maxillary and zygoma bones, unspecified, initial encounter (orbital fracture if concurrent)
S02.3XXAFracture of orbital floor, initial encounter
Z87.39Personal history of other musculoskeletal disorders (if relevant prior history)

External Cause Codes (Append as Secondary Diagnoses for Trauma)

ICD-10-CMDescription
W54.0XXABitten by dog, initial encounter
W54.1XXAStruck by dog, initial encounter
W55.01XABitten by cat, initial encounter
W25.XXXAContact with sharp glass, initial encounter
W26.0XXAContact with knife, initial encounter
W26.8XXAContact with other sharp object, initial encounter
W29.8XXAContact with other powered hand tools and household machinery, initial encounter
Y04.0XXAAssault by unarmed brawl or fight, initial encounter
Y09Assault by unspecified means
X00.0XXAExposure to flames in uncontrolled building fire, initial encounter

7th Character Assignment for Trauma Codes:

  • “A” (initial encounter) — used for the visit at which the wound is actively being treated, including the operative repair session
  • “D” (subsequent encounter) — used for follow-up visits during healing, including post-operative follow-up within the global period
  • “S” (sequela) — used for conditions that are late effects of a healed injury (e.g., lid notching, ectropion developing as a sequela of a previously repaired eyelid laceration)

Laterality Requirement: ICD-10-CM requires laterality (right vs. left) and, where applicable, upper vs. lower eyelid specification. “Unspecified” laterality codes should only be used when documentation genuinely does not specify the affected side — which should be rare in a surgical record. Always assign the most specific code available.

HCC Relevance

CPT 67930 is a CPT procedure code and does not itself carry an HCC assignment. The associated diagnosis codes for traumatic eyelid laceration (S01.1x1A) are trauma codes and are generally not HCC-mapped conditions.

ICD-10-CMHCC Assignment
S01.111A-S01.152ANo HCC — acute trauma codes
T26.01-T26.02No HCC — burn codes
H02.8xNo HCC — eyelid disorder codes
C44.111/C44.112HCC 12 — if repair is for malignant eyelid lesion (use 67961 in this scenario, not 67930)

HCC Note: Because CPT 67930 is used exclusively for traumatic (recent wound) eyelid repairs, the associated diagnoses are acute trauma codes that do not carry HCC weight in risk adjustment models. HCC-relevant malignancy codes (C44.1xx) associated with eyelid surgery should be paired with the excision-and-repair codes (67961/67966) rather than 67930. If an eyelid repair is being performed for a wound secondarily related to a patient’s known malignancy (e.g., trauma in a patient receiving anticoagulation for cancer-related thrombosis), the underlying malignancy should be coded as a secondary diagnosis for completeness and clinical accuracy, where it may contribute to HCC scoring.

wRVU and Reimbursement

MetricValue
Work RVU (wRVU)5.87
Total RVU (facility, national avg)~8.50
Total RVU (non-facility / office / ASC)~14.00-16.00
Global Period90 days
Assistant Surgeon PayableNo — assistant surgeon is generally not payable for CPT 67930 by Medicare; smaller defect not considered to require assistant
Co-SurgeonNot applicable
BilateralReport separately with -RT and -LT modifiers or modifier -50 per payer policy
Modifier -50Applicable if bilateral simultaneous eyelid repair is documented
Teaching PhysicianModifier -GC applicable in academic settings
Anesthesia CPT00140 — anesthesia for procedures on eye, not otherwise specified
Performed in Office / Minor Procedure RoomYes — frequently performed in office-based surgical suites or minor procedure rooms under local anesthesia
Performed in Emergency DepartmentYes — commonly performed by ophthalmology consultants in the ED setting

Assistant Surgeon Payability: Unlike CPT 67935 (which is assistant-payable due to the greater complexity and extent of reconstruction), CPT 67930 is generally not payable with an assistant surgeon under Medicare and most commercial payers. The smaller defect (25% or less of lid margin) is expected to be manageable by a single surgeon. If an assistant was present and performed a distinct surgical service at the same operative session (e.g., canalicular repair by a separate surgeon), that service is reported under the assistant’s own NPI with the appropriate code.

Global Period and ED Consultations: The 90-day global period applies to CPT 67930 regardless of the setting in which it is performed. Ophthalmologists who perform eyelid margin repairs as consultants in the emergency department should be aware that post-operative follow-up visits within 90 days for the same wound are included in the global package and are not separately billable. Visits for new or unrelated problems, or for complications requiring a return to the OR, follow different billing rules.

Non-Facility vs. Facility RVU Differential: The non-facility total RVU is substantially higher than the facility RVU because it incorporates practice expense for supplies, equipment, and personnel when the procedure is performed outside a hospital or ASC. When performed in the hospital outpatient department or ASC, the facility separately bills the technical component and the physician bills only the professional component (facility RVU rate).

MS-DRG Assignment

CPT 67930 is almost always performed in the outpatient, ASC, office, or emergency department setting. Inpatient admission for an isolated eyelid margin laceration requiring CPT 67930 would be unusual and clinically difficult to justify unless significant associated trauma (orbital fracture, globe injury, polytrauma) drives the inpatient stay. When an inpatient claim is generated in the context of complex facial trauma, the MS-DRG is driven by the principal diagnosis and the ICD-10-PCS codes assigned.

MS-DRGDescriptionType
116Intraocular Procedures with CC/MCCSurgical
117Intraocular Procedures without CC/MCCSurgical
124Other Disorders of the Eye with MCCMedical
125Other Disorders of the Eye without MCCMedical
963Other Multiple Significant Trauma with MCCSurgical — polytrauma context
964Other Multiple Significant Trauma with CCSurgical — polytrauma context
965Other Multiple Significant Trauma without CC/MCCSurgical

MS-DRG Coding Note: In the polytrauma context — where an eyelid laceration is one of multiple traumatic injuries — the MS-DRG is driven by the most resource-intensive injury and its associated surgical procedures. An isolated eyelid margin laceration repair in an inpatient setting would typically group to the eye surgical DRGs (116/117) if ICD-10-PCS procedure codes are assigned. If the eyelid repair is a minor component of a larger traumatic surgery (e.g., facial fracture repair, skull base fracture), the DRG is driven by the higher-weighted procedure. Accurate ICD-10-PCS coding of all procedures performed is essential to ensure the appropriate MS-DRG assignment and reimbursement.

ICD-10-PCS Equivalents (Inpatient Facility Coding)

For inpatient cases, ICD-10-PCS codes are required to capture eyelid repair. The primary root operation for suture repair of a traumatic eyelid wound is Repair (Q), defined in ICD-10-PCS as restoring a body part to its normal anatomic structure and function.

ICD-10-PCS CodeDescriptionClinical Application
08Q03ZZRepair of Right Upper Eyelid, Percutaneous ApproachFull-thickness right upper eyelid laceration repair
08Q13ZZRepair of Right Lower Eyelid, Percutaneous ApproachFull-thickness right lower eyelid laceration repair
08Q23ZZRepair of Left Upper Eyelid, Percutaneous ApproachFull-thickness left upper eyelid laceration repair
08Q33ZZRepair of Left Lower Eyelid, Percutaneous ApproachFull-thickness left lower eyelid laceration repair
08QX0ZZRepair of Right Upper Eyelid, External ApproachRepair via external approach (surface-level components)
08QY0ZZRepair of Left Upper Eyelid, External ApproachRepair via external approach
08RP0ZZRepair of Right Conjunctiva, External ApproachPalpebral conjunctival repair component
08RQ0ZZRepair of Left Conjunctiva, External ApproachPalpebral conjunctival repair component, left

ICD-10-PCS Approach Selection: The percutaneous approach (character value 3) is used when the repair is accomplished through instruments or sutures passed through the skin (as in layered suture repair through an open wound). The external approach (character value X) is used for procedures accomplished directly on the external surface of the body without skin penetration. For full-thickness eyelid laceration repairs involving tarsus and palpebral conjunctiva, the percutaneous approach (08Q03ZZ, 08Q13ZZ, etc.) is most appropriate, as the closure involves sutures passed through tissue layers beneath the surface. Confirm current-year ICD-10-PCS table definitions in your facility encoder before assigning.

Multiple ICD-10-PCS Codes: If both the eyelid (08Q0-08Q3) and the palpebral conjunctiva (08RP, 08RQ) are formally repaired and documented as distinct operative components, coding both the eyelid repair and the conjunctival repair codes is technically supported. However, in routine lid margin laceration repair, the conjunctival repair is integral to the eyelid repair and is typically captured by the single eyelid repair code. Encoder guidance and facility coding policy should direct this decision.

Coding Examples

Example 1 — Full-Thickness Lower Eyelid Margin Laceration, Right Eye, No Canalicular Involvement

A 28-year-old male presents to the emergency department following a laceration from broken glass. Ophthalmology is consulted. Examination reveals a 5 mm full-thickness laceration of the right lower eyelid at the lid margin, involving the gray line, tarsus, and palpebral conjunctiva. The wound is located 10 mm lateral to the medial canthus. The lower canaliculus is probed and irrigated — no canalicular involvement is identified. The globe is intact. The laceration represents approximately 18% of the total lower lid margin length (5 mm of a 28 mm lower lid). The patient is taken to the minor procedure room under monitored anesthesia care and local infiltration with 2% lidocaine with epinephrine.

The surgeon performs layered closure: 6-0 Vicryl sutures to the palpebral conjunctiva and tarsal plate (partial thickness, not penetrating conjunctival surface); three 5-0 silk sutures at the lid margin (gray line, meibomian orifice line, and lash line); and 6-0 nylon interrupted sutures to the eyelid skin with the silk suture tails incorporated under the skin closure.

CPT Code:

  • 67930-RT — Suture of recent wound, eyelid, involving lid margin, tarsus, and palpebral conjunctiva; not involving one-fourth of lid margin, right eye

ICD-10-CM:

  • S01.111A — Laceration without foreign body of right eyelid and periocular area, initial encounter
  • W25.XXXA — Contact with sharp glass, initial encounter

ICD-10-PCS (Inpatient):

  • 08Q13ZZ — Repair of Right Lower Eyelid, Percutaneous Approach

Example 2 — Full-Thickness Upper Eyelid Margin Laceration from Dog Bite, Left Eye, Child

A 7-year-old female presents following a dog bite to the left periocular region. Examination under general anesthesia in the operating room reveals a 4 mm full-thickness laceration of the left upper eyelid involving the lid margin, with adjacent skin lacerations totaling 2 cm. The wound involves approximately 14% of the upper lid margin (4 mm of a 29 mm upper lid). The upper canaliculus is probed — no canalicular involvement. No globe injury is identified. The surgeon performs layered full-thickness lid margin repair as described above, followed by simple skin closure of the adjacent periocular lacerations.

CPT Codes:

  • 67930-LT — Suture of recent wound, eyelid, involving lid margin; not involving one-fourth of lid margin, left upper eyelid (full-thickness lid margin repair)
  • 12013-59-LT — Simple repair of superficial wounds of face, eyelids; 2.6-5.0 cm (adjacent skin lacerations not involving lid margin, reported separately as a distinct wound)

ICD-10-CM:

  • S01.112A — Laceration without foreign body of left eyelid and periocular area, initial encounter
  • W54.0XXA — Bitten by dog, initial encounter

Coding Note: The full-thickness lid margin repair (67930) and the simple repair of the adjacent non-lid-margin skin lacerations (12013) are distinct wounds with distinct CPT codes and may be reported together. Modifier -59 on the skin repair code establishes that these are distinct procedures on distinct wounds. Do not add the wound lengths together — the lid margin repair is coded by extent (less than vs. more than one-fourth of lid margin), not by length, while the adjacent skin wounds are coded by total length.

Example 3 — Eyelid Margin Laceration with Canalicular Injury, Right Lower Lid

A 45-year-old male presents following a hook injury to the right medial canthal area. Examination reveals a 5 mm full-thickness laceration of the right lower eyelid at the lid margin, extending from the medial canthus laterally, involving approximately 19% of the lower lid margin. Probing and irrigation of the right lower punctum reveals a canalicular laceration with the probe visible in the wound. The patient is taken to the OR under general anesthesia for eyelid margin repair and canalicular intubation.

The surgeon places a monocanalicular silicone stent (Monoka stent) into the lower canaliculus with fixation at the punctum, and then performs layered full-thickness lid margin repair with 6-0 Vicryl to the conjunctiva and tarsus, 5-0 silk at the lid margin, and 6-0 nylon to the skin.

CPT Codes:

  • 67930-RT — Suture of recent wound, eyelid, involving lid margin, tarsus, and palpebral conjunctiva; not involving one-fourth of lid margin, right eye
  • 68700-RT — Plastic repair of canaliculi (canalicular laceration repair with monocanalicular stent intubation; separately reportable)

ICD-10-CM:

  • S01.111A — Laceration without foreign body of right eyelid and periocular area, initial encounter
  • S05.31XA — Ocular laceration without prolapse or loss of intraocular tissue, right eye, initial encounter (if globe involvement is documented)
  • W46.0XXA — Contact with hypodermic needle (if hook is classified as sharp penetrating object; use most appropriate W code for mechanism)

Key Coding Point: CPT 68700 (canalicular repair) is separately reportable when canalicular injury is identified and formally repaired with intubation. The canaliculus is a distinct anatomic structure (part of the lacrimal drainage system, not the eyelid margin or tarsus) with a distinct CPT code. Bundling 68700 into 67930 would be incorrect and would result in underreporting of the operative complexity.

Example 4 — Incorrect Code Selection Scenario (Common ED Billing Error)

A 32-year-old female presents to the ED with a 6 mm laceration of the right lower eyelid. The emergency physician notes the wound is “at the eyelid” and repairs it with layered closure. The billing department codes CPT 13151 (complex repair, eyelids, nose, ears, lips; 1.1-2.5 cm).

An ophthalmology consultant later reviews the record and determines from the documentation that the wound involved the lid margin and tarsus — full-thickness lid margin involvement.

Incorrectly Reported: 13151 — complex wound repair by length Correctly Reported: 67930-RT — Suture of recent wound, eyelid, involving lid margin, tarsus, and/or palpebral conjunctiva; not involving one-fourth of lid margin

Audit/Compliance Note: This is one of the most common eyelid coding errors in emergency medicine billing. Standard wound repair codes (12011-13152) are appropriate ONLY for eyelid wounds that do NOT involve the lid margin, tarsus, or palpebral conjunctiva. Full-thickness lid margin involvement — regardless of wound length — triggers the eyelid-specific code set (67930/67935). Emergency physicians and ophthalmology consultants should ensure documentation clearly states whether the wound involves the lid margin, tarsus, and/or palpebral conjunctiva. Coders should query when documentation is ambiguous.

Example 5 — Bilateral Eyelid Margin Lacerations Following Facial Trauma

A 19-year-old male sustains bilateral periorbital lacerations in a motor vehicle accident. Ophthalmology examines the patient in the trauma bay. Bilateral full-thickness lower eyelid margin lacerations are identified: right lower lid 5 mm (approximately 18% of right lower lid margin) and left lower lid 4 mm (approximately 15% of left lower lid margin). Both wounds involve tarsus and palpebral conjunctiva. No canalicular involvement bilaterally. Both wounds are repaired in the OR under general anesthesia.

CPT Codes:

  • 67930-RT — Suture of recent wound, eyelid, involving lid margin; not involving one-fourth of lid margin, right lower eyelid
  • 67930-LT-51 — Suture of recent wound, eyelid, involving lid margin; not involving one-fourth of lid margin, left lower eyelid (modifier -51 for multiple procedures; or use modifier -50 if payer prefers bilateral reporting on a single line)

ICD-10-CM:

  • S01.111A — Laceration without foreign body of right eyelid and periocular area, initial encounter
  • S01.112A — Laceration without foreign body of left eyelid and periocular area, initial encounter
  • V49.50XA — Driver injured in collision with unspecified motor vehicle in traffic accident, initial encounter (external cause)

Modifier Note: For bilateral procedures, some payers prefer modifier -50 on a single line with the base fee multiplied by 1.5 (Medicare standard). Others prefer two separate line items with -RT and -LT modifiers and modifier -51 on the second line item. Verify payer-specific bilateral billing requirements before submission.

Example 6 — Distinguishing 67930 from 67935 at the 25% Threshold

A 50-year-old male presents with a traumatic eyelid margin laceration of the right lower eyelid measuring 8 mm. The patient’s right lower lid measures 28 mm in total horizontal span. The wound involves the full thickness of the lid including tarsus and palpebral conjunctiva.

Calculation: 8 mm ÷ 28 mm = 28.6% — this exceeds 25% of the total lid margin.

Incorrect: 67930 (not involving one-fourth of lid margin) Correct: 67935 (over one-fourth of lid margin)

Documentation Guidance: When the wound is close to the 25% threshold, it is best practice for the surgeon to document both the absolute wound size in millimeters AND the estimated total lid margin width, allowing the coder to accurately calculate the percentage without ambiguity. A dictated statement such as “the wound measures 8 mm and involves approximately 29% of the right lower lid margin” provides unambiguous support for code selection. Coder queries are appropriate when this information is not documented.

Documentation Requirements

To support CPT 67930, the operative or procedure note must include:

  1. Diagnosis and mechanism — clearly state the nature of the wound (laceration, bite, puncture, burn) and mechanism of injury
  2. Laterality — right vs. left eye and upper vs. lower eyelid
  3. Full-thickness documentation — explicitly state that the wound involves the full thickness of the eyelid from skin surface to palpebral conjunctiva; note involvement of the tarsal plate and/or palpebral conjunctiva specifically
  4. Lid margin involvement — document that the laceration involves the lid margin (gray line, lash line, meibomian orifices); this distinguishes 67930/67935 from standard wound repair codes
  5. Wound dimensions and percentage — document the horizontal extent of the wound in millimeters AND the estimated total lid margin width or percentage involved; this is the critical factor distinguishing 67930 (≤25%) from 67935 (>25%)
  6. Canalicular assessment — document whether the canalicular system was evaluated for involvement; state findings (canaliculus intact vs. lacerated); if lacerated, document intubation and report 68700 separately
  7. Globe assessment — document that the globe was examined and found to be intact, or document any globe injury identified
  8. Operative technique — describe the layered closure in sufficient detail: suture materials used at each layer (conjunctiva/tarsus, lid margin, orbicularis, skin), suture technique (interrupted vs. running, partial vs. full thickness), and number/placement of lid margin sutures
  9. Anesthesia type — local infiltration, MAC, or general anesthesia
  10. Associated injuries — document all associated periocular or orbital injuries identified at the same examination/operative session

Clinical Notes for Coders

  • The 25% threshold is not always explicitly stated in operative reports. Coders should look for the wound size in millimeters and, if the total lid width is not documented, may need to apply standard anatomic knowledge (average lower lid approximately 28-30 mm, upper lid approximately 30-32 mm) as a reference, while recognizing that individual variation exists. When in doubt, query the surgeon.

  • Lid margin involvement is the key qualifier separating 67930/67935 from simple wound repair codes (12011-13152). Many eyelid lacerations that appear superficial actually involve the lid margin; conversely, some deep eyelid lacerations may not involve the lid margin at all. Documentation must explicitly address whether the wound involves the lid margin, tarsus, and/or palpebral conjunctiva.

  • Emergency department billing for eyelid margin laceration repairs is an area of frequent coding error. Emergency physicians and advanced practice providers who repair eyelid margin lacerations may not be aware of the eyelid-specific CPT code set and may default to wound repair codes. Ophthalmology consultants who perform the repair in the ED should bill under their own NPI using 67930/67935 as appropriate.

  • Pediatric patients frequently present with eyelid lacerations from dog bites and falls. General anesthesia is often required for operative repair in young children, which increases the clinical complexity but does not change the CPT code — 67930 is the appropriate code regardless of anesthesia type as long as the wound meets the inclusion criteria.

  • Post-operative lid notching — a V-shaped deformity at the repaired lid margin — is a known complication of imprecise lid margin repair and may present within the 90-day global period. If the notching requires a return to the OR for revision during the global period, modifier -78 (unplanned return to OR for complication) must be appended to the revision procedure code and a separate evaluation of the original surgeon’s technical performance may be appropriate.

  • Wound dehiscence during the global period may be managed in the office (not separately billable if within the global) or in the OR (separately billable with modifier -78 for unplanned return to OR). Document the clinical scenario carefully to support the appropriate billing pathway.

  • Silicone stent removal — if a monocanalicular or bicanalicular silicone stent was placed during canalicular repair at the same session (68700), the stent is typically removed in the office at 3-6 months. Stent removal during the global period of 67930 may be separately reportable as it relates to the canalicular repair (68700) rather than the eyelid margin repair itself. Review global period overlap between 67930 and 68700 when both are performed at the same session.

  • Wound repair vs. reconstruction codes — 67930 is a repair code for recent wounds. If a patient presents with an old, chronic, or previously attempted eyelid defect requiring reconstructive techniques (flaps, grafts, staged procedures), the reconstructive CPT codes (67961, 67966, 67971-67975) are more appropriate. The word “recent” in the 67930 descriptor implies primary repair of an acute wound, not reconstruction of a chronic defect.

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