How To Use CPT Code 68815

CPT 68815 describes the procedure of probing the nasolacrimal duct, with or without irrigation, and the insertion of a tube or stent to keep the duct open. 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 68815?

CPT 68815 is used to describe the procedure of probing the nasolacrimal duct, with or without irrigation, and the insertion of a tube or stent to maintain the openness of the duct. This code is used when a healthcare provider performs the procedure to identify any obstructions or strictures in the nasolacrimal duct.

2. Official Description

The official description of CPT code 68815 is: ‘Probing of nasolacrimal duct, with or without irrigation; with insertion of tube or stent.’

3. Procedure

1. The healthcare provider prepares the patient and administers anesthesia.
2. The provider dilates the lacrimal drainage system and inserts a punctal dilator to widen the punctum.
3. A probe is inserted into the punctum and passed through until a hard stop is reached.
4. The provider may perform irrigation of the canaliculus with fluorescein-stained saline.
5. If necessary, further irrigation may be performed.
6. To maintain patency, a stent (silicon intubation) is placed in the narrowed area for a specific period of time.
7. The cannula is removed, and antibiotics are instilled.

4. Qualifying circumstances

CPT 68815 is performed on patients who require probing of the nasolacrimal duct to identify any obstructions or strictures. The procedure may or may not involve irrigation. The insertion of a tube or stent is done to keep the duct open and maintain patency. This procedure is typically performed by a healthcare provider who specializes in ophthalmology or oculoplastic surgery.

5. When to use CPT code 68815

CPT code 68815 should be used when a healthcare provider performs the probing of the nasolacrimal duct, with or without irrigation, and inserts a tube or stent to maintain the openness of the duct. This code should not be used for procedures such as dilation of the lacrimal punctum or probing of lacrimal canaliculi, as there are separate codes for those procedures.

6. Documentation requirements

To support a claim for CPT 68815, the healthcare provider must document the following information:

• Patient’s diagnosis and the need for probing of the nasolacrimal duct
• Specific details of the procedure performed, including whether irrigation was done
• Date of the procedure
• Start and end time of the procedure
• Any complications or additional interventions performed
• Signature of the healthcare provider performing the procedure

7. Billing guidelines

When billing for CPT 68815, ensure that the procedure is performed by a qualified healthcare provider and includes the probing of the nasolacrimal duct, with or without irrigation, and the insertion of a tube or stent. Modifier 50 should be appended if the procedure is performed bilaterally. It is important to note that CPT 68815 should not be reported with other codes such as 68810, 68801, or 68840, as they represent different procedures. Each code should be reported separately based on the specific procedure performed.

8. Historical information

CPT 68815 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 healthcare provider performs probing of the nasolacrimal duct, with irrigation, and inserts a tube to maintain patency for a patient with chronic tear duct obstruction.
2. During a procedure, a healthcare provider probes the nasolacrimal duct, without irrigation, and inserts a stent to keep the duct open for a patient with recurrent tear duct blockage.
3. A patient undergoes probing of the nasolacrimal duct, with irrigation, and the insertion of a tube to maintain patency after experiencing a tear duct injury.
4. A healthcare provider performs probing of the nasolacrimal duct, without irrigation, and inserts a stent to keep the duct open for a patient with congenital tear duct stenosis.
5. During a procedure, a healthcare provider probes the nasolacrimal duct, with irrigation, and inserts a tube to maintain patency for a patient with chronic dacryocystitis.
6. A patient undergoes probing of the nasolacrimal duct, without irrigation, and the insertion of a stent to keep the duct open after experiencing tear duct trauma.
7. A healthcare provider performs probing of the nasolacrimal duct, with irrigation, and inserts a tube to maintain patency for a patient with tear duct obstruction due to a tumor.
8. During a procedure, a healthcare provider probes the nasolacrimal duct, without irrigation, and inserts a stent to keep the duct open for a patient with tear duct stricture.
9. A patient undergoes probing of the nasolacrimal duct, with irrigation, and the insertion of a tube to maintain patency after experiencing recurrent tear duct infections.