How To Use CPT Code 68130

CPT 68130 describes the excision of a lesion on the conjunctiva and the accompanying scleral tissue. This article will cover the description, procedure, qualifying circumstances, appropriate usage, documentation requirements, billing guidelines, historical information and billing examples.

1. What is CPT Code 68130?

CPT 68130 is used to describe the excision of a lesion on the conjunctiva, which is the mucous membrane that lines the inner surface of the eyelid, along with the adjacent scleral tissue. This procedure is performed to alleviate pain, pressure, and improve vision for the patient.

2. Official Description

The official description of CPT code 68130 is: ‘Excision of lesion, conjunctiva; with adjacent sclera.’

3. Procedure

1. After the patient is appropriately prepped and anesthetized, the healthcare provider places a lid speculum to keep the eye open and examines the eye.
2. A traction suture is placed to the nasal limbus, which is the differentiating border or edge, to provide stability during the procedure.
3. A corneal light shield is used to protect the eye from phototoxicity, which is skin irritation caused by a chemical.
4. The provider marks the lesion on the conjunctiva and sclera using a fine tip marker, leaving a margin or surrounding area of approximately 3 to 4 mm.
5. The lesion is then excised, and if necessary, the incision is sutured.

4. Qualifying circumstances

CPT 68130 is performed when there is a lesion on the conjunctiva and the accompanying scleral tissue that requires excision. The procedure is typically done to alleviate pain, pressure, and improve vision for the patient. It is important to note that if the provider performs an excisional biopsy, where the entire lesion is removed and sent for biopsy, a different code should be used.

5. When to use CPT code 68130

CPT code 68130 should be used when the healthcare provider performs the excision of a lesion on the conjunctiva and the adjacent scleral tissue. It is important to review the operative note to ensure that the provider performed a full excision of the lesion and not just a biopsy. If a biopsy was performed, a different code should be used, such as CPT code 68100 for a biopsy of the conjunctiva.

6. Documentation requirements

To support a claim for CPT code 68130, the healthcare provider must document the following information:

• Patient’s diagnosis and the need for the excision of the lesion
• Details of the procedure, including the use of lid speculum, traction suture, corneal light shield, and the size of the margin around the lesion
• Date of the procedure
• Any complications or additional procedures performed
• Signature of the healthcare provider performing the procedure

7. Billing guidelines

When billing for CPT code 68130, ensure that the excision of the lesion on the conjunctiva and the adjacent scleral tissue is performed. It is important to review the operative note to determine if the provider performed a full excision or just a biopsy. If a biopsy was performed, a different code should be used. It is also important to follow any specific guidelines provided by the payer regarding the use of this code.

8. Historical information

CPT code 68130 was added to the Current Procedural Terminology system on January 1, 1990. There have been no updates or changes to the code since its addition.

9. Examples

1. A healthcare provider performs the excision of a lesion on the conjunctiva and the adjacent scleral tissue to alleviate pain and improve vision for a patient.
2. During a surgical procedure, a lesion on the conjunctiva and the accompanying scleral tissue is excised by a healthcare provider to relieve pressure and improve the patient’s vision.
3. A patient undergoes the excision of a lesion on the conjunctiva and the adjacent scleral tissue to alleviate discomfort and enhance their visual acuity.
4. A healthcare provider performs the excision of a lesion on the conjunctiva and the accompanying scleral tissue to address a patient’s complaint of pain and to improve their overall eye health.
5. During a surgical procedure, a lesion on the conjunctiva and the adjacent scleral tissue is excised by a healthcare provider to alleviate symptoms and improve the patient’s quality of life.
6. A patient undergoes the excision of a lesion on the conjunctiva and the accompanying scleral tissue to alleviate discomfort and improve their visual function.
7. A healthcare provider performs the excision of a lesion on the conjunctiva and the adjacent scleral tissue to alleviate pain and pressure for a patient.
8. During a surgical procedure, a lesion on the conjunctiva and the accompanying scleral tissue is excised by a healthcare provider to improve the patient’s vision and overall eye health.
9. A patient undergoes the excision of a lesion on the conjunctiva and the adjacent scleral tissue to alleviate discomfort and enhance their visual acuity.
10. A healthcare provider performs the excision of a lesion on the conjunctiva and the accompanying scleral tissue to address a patient’s complaint of pain and to improve their overall eye health.