How To Use CPT Code 68530

CPT 68530 describes the removal of a foreign body or dacryolith from the lacrimal passages, specifically the lacrimal gland or sac. 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 68530?

CPT 68530 is used to describe the surgical procedure of removing a foreign body or stone from the lacrimal gland or sac. This code is used when there is an obstruction or blockage of the tear duct that requires intervention. The provider makes an incision in the lacrimal passages, removes the foreign body or stone, checks for bleeding, and closes the incisions with sutures.

2. Official Description

The official description of CPT code 68530 is the “Removal of foreign body or dacryolith, lacrimal passages.” This code specifically refers to the removal of a foreign body or stone from the lacrimal gland or sac to treat obstruction of the tear duct.

3. Procedure

1. The provider prepares the patient for the procedure, ensuring appropriate anesthesia and prepping the area.
2. An incision is made in the lacrimal passages to access the lacrimal gland or sac.
3. The foreign body or stone is carefully removed from the lacrimal gland or sac.
4. The provider checks for any bleeding and ensures hemostasis.
5. The incisions in the lacrimal structures are closed with sutures.
6. The patient is observed for a brief period and then released.

4. Qualifying circumstances

CPT 68530 is performed when there is a foreign body or stone causing obstruction or blockage of the tear duct. This procedure is necessary to restore proper tear drainage and prevent complications. The patient must have a documented need for the removal of the foreign body or stone in the lacrimal gland or sac.

5. When to use CPT code 68530

CPT code 68530 should be used when a foreign body or stone needs to be removed from the lacrimal gland or sac. It is important to ensure that the procedure is performed for the purpose of treating obstruction or blockage of the tear duct. This code should not be used for other lacrimal system procedures or unrelated conditions.

6. Documentation requirements

To support a claim for CPT 68530, the provider must document the following information:

• The reason for the procedure, including the presence of a foreign body or stone causing obstruction or blockage of the tear duct
• Details of the procedure, including the incision made, removal of the foreign body or stone, and closure of the incisions
• Any complications or additional procedures performed
• Signature of the provider performing the procedure

7. Billing guidelines

When billing for CPT 68530, ensure that the procedure meets the criteria for this code, including the removal of a foreign body or stone from the lacrimal gland or sac. It is important to follow the appropriate coding guidelines and documentation requirements. CPT code 68530 should not be reported with other lacrimal system procedures unless they are distinct and separate from the foreign body or stone removal.

8. Historical information

CPT 68530 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 presents with a foreign body in their lacrimal gland, causing obstruction of the tear duct. The provider performs CPT 68530 to remove the foreign body and restore proper tear drainage.
2. During a routine examination, a stone is discovered in the lacrimal sac of a patient. The provider performs CPT 68530 to remove the stone and alleviate the blockage of the tear duct.
3. A patient experiences recurrent infections due to a foreign body in their lacrimal gland. The provider performs CPT 68530 to remove the foreign body and prevent further complications.
4. After an injury, a patient develops a stone in their lacrimal sac, leading to tear duct obstruction. The provider performs CPT 68530 to remove the stone and restore normal tear drainage.
5. A foreign body becomes lodged in a patient’s lacrimal gland, causing discomfort and tearing. The provider performs CPT 68530 to remove the foreign body and improve the patient’s symptoms.