How To Use CPT Code 68520

CPT 68520 describes the excision of the lacrimal sac, also known as dacryocystectomy. This article will cover the official description, procedure, qualifying circumstances, appropriate usage, documentation requirements, billing guidelines, historical information and billing examples.

1. What is CPT Code 68520?

CPT 68520 is used to describe the surgical removal of the lacrimal sac, which is the tear duct. This procedure is performed to treat dacryocystitis, which is inflammation of the tear duct. During the procedure, the provider makes an incision in the lower eyelid and removes the lacrimal sac. The incision is then closed in layers.

2. Official Description

The official description of CPT code 68520 is: ‘Excision of lacrimal sac (dacryocystectomy).’ This code is used when the provider surgically removes the lacrimal sac to treat dacryocystitis.

3. Procedure

1. The patient is appropriately prepped and anesthetized for the procedure.
2. The provider makes an incision in the lower eyelid to access the lacrimal sac.
3. The attachments to the lacrimal sac and surrounding structures are freed up.
4. The provider excises the lacrimal sac.
5. Bleeding is checked and controlled if necessary.
6. The incision in the eyelid is closed in layers.

4. Qualifying circumstances

CPT 68520 is performed when a patient has dacryocystitis, which is inflammation of the tear duct. The procedure is typically performed by a qualified healthcare provider who has the necessary training and expertise in performing lacrimal sac excision. The patient must have a documented diagnosis of dacryocystitis and meet the criteria for surgical intervention.

5. When to use CPT code 68520

CPT code 68520 should be used when a provider performs the excision of the lacrimal sac to treat dacryocystitis. It is important to ensure that the patient meets the qualifying circumstances for the procedure and that the documentation supports the medical necessity of the surgery.

6. Documentation requirements

To support a claim for CPT 68520, the provider must document the following information:

• Patient’s diagnosis of dacryocystitis
• Details of the surgical procedure, including the incision site and technique
• Any complications or additional procedures performed
• Post-operative care instructions
• Signature of the provider performing the procedure

7. Billing guidelines

When billing for CPT 68520, ensure that the documentation supports the medical necessity of the procedure and that the patient meets the qualifying circumstances. It is important to follow the specific guidelines provided by the payer and use the appropriate modifiers if necessary. CPT code 68520 should not be reported with other codes that describe excision procedures on the lacrimal system.

8. Historical information

CPT 68520 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 with chronic dacryocystitis undergoes an excision of the lacrimal sac to alleviate symptoms and prevent recurrent infections.
2. A provider performs a dacryocystectomy on a patient with a history of recurrent tear duct infections and blockages.
3. A child with congenital dacryocystitis undergoes a surgical removal of the lacrimal sac to restore normal tear drainage.
4. A patient with a persistent tear duct abscess undergoes an excision of the lacrimal sac to resolve the infection.
5. A provider performs a dacryocystectomy on a patient with a lacrimal sac tumor to remove the malignant growth.
6. An adult with chronic dacryocystitis undergoes an excision of the lacrimal sac to improve tear drainage and alleviate symptoms.
7. A patient with a history of recurrent tear duct infections and blockages undergoes a dacryocystectomy to prevent further complications.
8. A provider performs an excision of the lacrimal sac on a patient with a lacrimal sac abscess to drain the infection and promote healing.
9. A child with congenital dacryocystitis undergoes a surgical removal of the lacrimal sac to prevent recurrent infections and improve tear drainage.
10. A patient with chronic dacryocystitis and persistent symptoms undergoes an excision of the lacrimal sac to alleviate discomfort and improve tear flow.