How To Use CPT Code 68761

CPT 68761 is a medical procedure code for the closure of the lacrimal punctum by plug insertion, used to treat dry eye syndrome. This article will cover the description, procedure, qualifying circumstances, when to use the code, documentation requirements, billing guidelines, historical information, similar codes, and examples of CPT 68761 procedures.

1. What is CPT 68761?

CPT 68761 is a medical procedure code that refers to the closure of the lacrimal punctum by inserting a plug. This procedure is performed to treat dry eye syndrome by blocking excessive drainage of tears. The code is used by medical coders and billers to accurately document and bill for this specific procedure.

2. 68761 CPT code description

The official description of CPT code 68761 is: “Closure of the lacrimal punctum; by plug, each.”

3. Procedure

The CPT 68761 procedure involves the following steps:

1. The patient is appropriately prepped, and the provider may instill drops to anesthetize the eye.
2. The provider dilates the punctum to make it easier to insert the plug.
3. A disposable forceps-like device or syringe is used to insert the plug.
4. Depending on the material, plugs may be temporary or semi-permanent.
5. The provider releases the patient after a short recovery period.

4. Qualifying circumstances

Patients who are eligible to receive CPT code 68761 services are those diagnosed with dry eye syndrome or other conditions that cause excessive tear drainage. The procedure is typically performed when conservative treatments, such as artificial tears or medications, have not provided sufficient relief for the patient’s symptoms. A thorough evaluation by an ophthalmologist or optometrist is necessary to determine if the patient is a suitable candidate for the procedure.

5. When to use CPT code 68761

It is appropriate to bill the 68761 CPT code when the provider has performed the closure of the lacrimal punctum by inserting a plug to treat dry eye syndrome or other conditions causing excessive tear drainage. The code should be used only when the procedure has been deemed medically necessary by a qualified healthcare professional.

6. Documentation requirements

To support a claim for CPT 68761, the following information needs to be documented:

• Patient’s medical history and diagnosis of dry eye syndrome or other relevant condition.
• A detailed description of the procedure, including the type of plug used and the specific punctum treated.
• Documentation of the patient’s response to conservative treatments and the rationale for performing the procedure.
• Any relevant pre- and post-operative care instructions provided to the patient.
• Follow-up appointments or additional treatments, if necessary.

7. Billing guidelines

When billing for CPT code 68761, it is important to follow the appropriate guidelines and rules. Use E modifiers when the procedure can be performed on any one of the four eyelids: E1 for upper left, E2 for lower left, E3 for upper right, and E4 for lower right. These modifiers do not affect payment but provide the payer with more clinical information. Non-Medicare payers may pay for the plug supply, while other payers may prefer 99070 for supplies and materials provided by the provider over and above those usually included with the office visit or other services rendered.

8. Historical information

CPT 68761 was added to the Current Procedural Terminology system on January 1, 1993. There have been no updates to the code since its addition.

9. Similar codes to CPT 68761

Five similar codes to CPT 68761 and how they differentiate are:

1. CPT 68801: This code refers to the dilation of the lacrimal punctum, without the insertion of a plug.
2. CPT 68810: This code is used for the probing of the lacrimal duct, which is a diagnostic procedure to assess the patency of the duct.
3. CPT 68840: This code involves the probing of the lacrimal canaliculi, another diagnostic procedure to evaluate the patency of the canaliculi.
4. CPT 68841: This code is for the insertion and removal of a drug-eluting implant into the lacrimal canaliculus for intraocular pressure management.
5. Codes 0444T and 0445T: These codes are used for the placement of a drug-eluting insert under the eyelid(s) for the treatment of ocular conditions.

10. Examples

Here are 10 detailed examples of CPT code 68761 procedures:

1. A 55-year-old patient with a history of dry eye syndrome undergoes the insertion of a temporary plug in the lower left punctum (E2) after conservative treatments have failed to provide relief.
2. A 67-year-old patient with Sjögren’s syndrome has a semi-permanent plug inserted in both the upper left (E1) and lower left (E2) puncta to alleviate severe dry eye symptoms.
3. A 42-year-old patient with chronic blepharitis undergoes the insertion of a temporary plug in the lower right punctum (E4) to reduce excessive tear drainage.
4. A 60-year-old patient with a history of dry eye syndrome has a semi-permanent plug inserted in the upper right punctum (E3) after other treatments have been unsuccessful.
5. A 48-year-old patient with a history of dry eye syndrome undergoes the insertion of a temporary plug in the upper left punctum (E1) to alleviate symptoms.
6. A 71-year-old patient with a history of dry eye syndrome has a semi-permanent plug inserted in the lower left punctum (E2) after conservative treatments have failed to provide relief.
7. A 53-year-old patient with a history of dry eye syndrome undergoes the insertion of a temporary plug in the upper right punctum (E3) to reduce excessive tear drainage.
8. A 62-year-old patient with a history of dry eye syndrome has a semi-permanent plug inserted in the lower right punctum (E4) after other treatments have been unsuccessful.
9. A 50-year-old patient with a history of dry eye syndrome undergoes the insertion of a temporary plug in the upper left punctum (E1) to alleviate symptoms.
10. A 65-year-old patient with a history of dry eye syndrome has a semi-permanent plug inserted in the lower left punctum (E2) after conservative treatments have failed to provide relief.