How To Use CPT Code 68720

CPT 68720 describes a surgical procedure known as dacryocystorhinostomy (DCR), which is performed to correct dysfunction of the nasolacrimal duct and restore the flow of tears from the tear duct into the nose. This article will cover the description, official description, procedure, qualifying circumstances, appropriate usage, documentation requirements, billing guidelines, historical information and billing examples.

1. What is CPT Code 68720?

CPT 68720 is a code used to describe the surgical procedure called dacryocystorhinostomy (DCR). This procedure is performed to correct issues with the nasolacrimal duct, which is responsible for draining tears from the tear duct into the nose. By performing a DCR, the healthcare provider aims to restore the normal flow of tears and alleviate symptoms associated with a dysfunctional nasolacrimal duct.

2. Official Description

The official description of CPT code 68720 is: ‘Dacryocystorhinostomy (fistulization of lacrimal sac to nasal cavity).’ This procedure involves creating a passageway between the lacrimal sac (tear duct) and the nasal cavity to facilitate tear drainage.

3. Procedure

1. To perform a dacryocystorhinostomy (DCR), the healthcare provider begins by preparing and anesthetizing the patient.
2. Next, the provider makes an incision on the side of the nose and removes a small portion of nasal bone.
3. A tube is inserted into the created passageway to prevent closure and allow tears to flow into the nose.
4. The provider checks for any bleeding, removes any instruments used during the procedure, and observes the patient for a short period.
5. After the wounds have healed, the tube will be removed by the provider.

4. Qualifying circumstances

CPT 68720 is performed when there is dysfunction of the nasolacrimal duct, leading to impaired tear drainage. This procedure is indicated for patients who experience symptoms such as excessive tearing, recurrent eye infections, or swelling around the tear duct area. The healthcare provider must evaluate the patient’s condition and determine that a dacryocystorhinostomy is necessary to restore normal tear flow.

5. When to use CPT code 68720

CPT code 68720 should be used when a healthcare provider performs a dacryocystorhinostomy to correct dysfunction of the nasolacrimal duct. This code is specific to the surgical procedure and should not be used for other related services or treatments.

6. Documentation requirements

To support a claim for CPT 68720, the healthcare provider must document the following information:

• Patient’s symptoms and diagnosis indicating dysfunction of the nasolacrimal duct
• Details of the surgical procedure performed, including the incision and insertion of the tube
• Date of the procedure
• Any complications or follow-up care required
• Provider’s signature

7. Billing guidelines

When billing for CPT 68720, ensure that the procedure performed aligns with the official description of the code. It is important to accurately document the procedure and provide any necessary supporting documentation. CPT 68720 should not be reported with other codes unless specific circumstances warrant it. It is advisable to review the official coding guidelines and consult with the payer for any specific billing requirements or considerations.

8. Historical information

CPT 68720 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 tearing undergoes dacryocystorhinostomy to correct a dysfunctional nasolacrimal duct.
2. A healthcare provider performs a dacryocystorhinostomy on a patient with recurrent eye infections due to impaired tear drainage.
3. A patient with swelling and discomfort around the tear duct area undergoes dacryocystorhinostomy to alleviate symptoms.
4. A healthcare provider performs a dacryocystorhinostomy on a patient with excessive tearing that affects their daily activities.
5. A patient with a history of nasolacrimal duct obstruction undergoes dacryocystorhinostomy to restore normal tear flow.
6. A healthcare provider performs a dacryocystorhinostomy on a patient with chronic eye irritation and discharge.
7. A patient with a congenital nasolacrimal duct obstruction undergoes dacryocystorhinostomy to improve tear drainage.
8. A healthcare provider performs a dacryocystorhinostomy on a patient with a history of recurrent eye infections and tear duct blockage.
9. A patient with persistent tearing and discomfort undergoes dacryocystorhinostomy to address the underlying issue.
10. A healthcare provider performs a dacryocystorhinostomy on a patient with a traumatic injury to the tear duct area.