How To Use CPT Code 68801

CPT 68801 describes the dilation of the lacrimal punctum, a procedure that may or may not include irrigation. This article will cover the description, official details, procedure, qualifying circumstances, appropriate usage, documentation requirements, billing guidelines, historical information and billing examples.

1. What is CPT Code 68801?

CPT 68801 is used to describe the dilation of the lacrimal punctum, which is the opening that allows tears to drain from the conjunctival sac into the lacrimal duct in the eye. This procedure may or may not involve irrigation of the punctum. It is typically performed to treat conditions such as injury, blockage, or punctal stenosis, which can cause excessive tearing or epiphora.

2. Official Description

The official description of CPT code 68801 is: ‘Dilation of lacrimal punctum, with or without irrigation.’ If the procedure is performed bilaterally, modifier 50 should be appended to the code.

3. Procedure

1. The provider begins by preparing and anesthetizing the patient.
2. Using a small metal dilating tool, the provider dilates the lacrimal punctum.
3. A thin flexible probe, catheter, or suture is then gently inserted through the punctum and moved through the lacrimal system.
4. If necessary, the provider may perform irrigation of the punctum using a sterile liquid to ensure proper drainage.

4. Qualifying circumstances

CPT 68801 is typically performed when there is an injury, blockage, or punctal stenosis that causes excessive tearing or epiphora. The procedure is appropriate for patients who have narrowed punctal openings due to inflammation. It is important to note that this procedure should be performed by a qualified healthcare professional.

5. When to use CPT code 68801

CPT code 68801 should be used when the provider performs the dilation of the lacrimal punctum, with or without irrigation. It is important to accurately document the procedure and ensure that it meets the criteria outlined in the official description.

6. Documentation requirements

To support a claim for CPT 68801, the provider must document the following information:

• Patient’s condition or diagnosis necessitating the procedure
• Details of the procedure performed, including whether irrigation was included
• Date of the procedure
• Any complications or additional interventions
• Signature of the performing provider

7. Billing guidelines

When billing for CPT 68801, ensure that the procedure meets the requirements outlined in the official description. If the procedure is performed bilaterally, modifier 50 should be appended to the code. It is important to follow the specific guidelines provided by the payer to ensure accurate and appropriate reimbursement.

8. Historical information

CPT 68801 was added to the Current Procedural Terminology system on January 1, 1997. There have been no updates or changes to the code since its addition.

9. Examples

1. A patient presents with epiphora due to a narrowed punctal opening. The provider performs dilation of the lacrimal punctum without irrigation.
2. A patient has a blockage in the lacrimal punctum causing excessive tearing. The provider performs dilation of the punctum and includes irrigation to ensure proper drainage.
3. A patient undergoes a bilateral dilation of the lacrimal punctum without irrigation to address punctal stenosis.
4. A provider performs dilation of the lacrimal punctum with irrigation for a patient with an injury that has resulted in epiphora.
5. A patient presents with a narrowed punctal opening due to inflammation. The provider performs dilation of the punctum without irrigation to alleviate the symptoms of excessive tearing.
6. A provider performs dilation of the lacrimal punctum with irrigation for a patient with a blockage that is causing epiphora.
7. A patient undergoes a bilateral dilation of the lacrimal punctum without irrigation to address punctal stenosis.
8. A provider performs dilation of the lacrimal punctum with irrigation for a patient with an injury that has resulted in epiphora.
9. A patient presents with a narrowed punctal opening due to inflammation. The provider performs dilation of the punctum without irrigation to alleviate the symptoms of excessive tearing.
10. A provider performs dilation of the lacrimal punctum with irrigation for a patient with a blockage that is causing epiphora.