How To Use CPT Code 68328

CPT 68328 describes a surgical procedure known as conjunctivoplasty with buccal mucous membrane graft. This article will provide an overview of the code, including its official description, the procedure involved, qualifying circumstances, appropriate usage, documentation requirements, billing guidelines, historical information and billing examples.

1. What is CPT Code 68328?

CPT 68328 is a code used to describe a specific surgical procedure called conjunctivoplasty with buccal mucous membrane graft. This procedure involves the removal of diseased tissue from the conjunctiva and the grafting of a new membrane to the eye. It is typically performed to treat conditions such as conjunctival chalasis, which is the relaxation of the conjunctiva.

2. Official Description

The official description of CPT code 68328 is: ‘Conjunctivoplasty, reconstruction cul-de-sac; with buccal mucous membrane graft (includes obtaining graft).’ This code specifically refers to the surgical repair of the conjunctiva using a buccal mucous membrane graft.

3. Procedure

1. During the conjunctivoplasty procedure, the provider first prepares the patient by ensuring appropriate prepping and anesthesia.
2. Next, the provider surgically separates buccal mucous tissue, which is the lining of the mucous membrane inside the mouth.
3. The graft site is then prepared to receive the graft tissue.
4. The provider sutures the graft material into a cul-de-sac or pouch within the conjunctiva.
5. The graft is securely sutured into place, and the eye is irrigated to ensure proper healing.

4. Qualifying circumstances

CPT 68328 is typically performed on patients who have conditions that require the repair and reconstruction of the conjunctiva. These conditions may include conjunctival chalasis or other issues affecting the mucous membrane lining the inner surface of the eyelid. The procedure is performed by a qualified healthcare professional who has the necessary expertise in conjunctivoplasty and buccal mucous membrane grafting.

5. When to use CPT code 68328

CPT code 68328 should be used when the provider performs a conjunctivoplasty procedure with a buccal mucous membrane graft. It is important to note that if the provider does not obtain a buccal mucous membrane graft during the procedure, a different code, such as 68320, should be used instead.

6. Documentation requirements

To support a claim for CPT 68328, the healthcare professional must document the following information:

• Patient’s diagnosis and the need for conjunctivoplasty with buccal mucous membrane graft
• Details of the procedure, including the specific steps taken and any complications encountered
• Date of the procedure
• Start and end time of the procedure
• Any additional relevant information, such as the size of the graft or any specific techniques used
• Signature of the healthcare professional performing the procedure

7. Billing guidelines

When billing for CPT 68328, it is important to ensure that the procedure performed aligns with the code’s description. The provider should be qualified and experienced in performing conjunctivoplasty with buccal mucous membrane graft. It is also essential to follow any specific guidelines or requirements set by the payer or insurance company.

8. Historical information

CPT code 68328 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 patient undergoes conjunctivoplasty with buccal mucous membrane graft to treat conjunctival chalasis.
2. A provider performs conjunctivoplasty with buccal mucous membrane graft to repair a defect in the conjunctiva caused by trauma.
3. A patient with a history of conjunctival issues undergoes conjunctivoplasty with buccal mucous membrane graft to improve their ocular health.
4. A provider performs conjunctivoplasty with buccal mucous membrane graft as part of a larger reconstructive procedure for the eye.
5. A patient with a congenital conjunctival abnormality undergoes conjunctivoplasty with buccal mucous membrane graft to correct the issue.
6. A provider performs conjunctivoplasty with buccal mucous membrane graft to address complications from a previous eye surgery.
7. A patient with chronic conjunctival inflammation undergoes conjunctivoplasty with buccal mucous membrane graft to alleviate their symptoms.
8. A provider performs conjunctivoplasty with buccal mucous membrane graft to repair a conjunctival defect caused by a tumor removal.
9. A patient with a history of conjunctival scarring undergoes conjunctivoplasty with buccal mucous membrane graft to improve their visual function.
10. A provider performs conjunctivoplasty with buccal mucous membrane graft to address complications from a previous eye infection.