How To Use CPT Code 68816

CPT 68816 describes the procedure of probing the nasolacrimal duct, with or without irrigation, and includes transluminal balloon catheter dilation. 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 68816?

CPT 68816 is used to describe a specific procedure involving the probing of the nasolacrimal duct, which is the passage between the tear ducts and the nose. This procedure may also include irrigation and the use of a transluminal balloon catheter for dilation. It is performed to correct the narrowing or stricture of the duct.

2. Official Description

The official description of CPT code 68816 is: ‘Probing of nasolacrimal duct, with or without irrigation; with transluminal balloon catheter dilation.’ It is important to note that this code should not be reported in conjunction with codes 68810, 68811, or 68815. For a bilateral procedure, modifier 50 should be appended to the code.

3. Procedure

1. The provider begins by prepping and anesthetizing the patient appropriately.
2. The punctum, which is the opening at the inner corner of the eye, is dilated.
3. A probe is then passed into the inferior or superior punctum and advanced through the nasolacrimal duct until it reaches a hard stop.
4. The canaliculus, or tear duct, is irrigated with a saline solution containing a dye.
5. A balloon is inserted through a catheter into the lacrimal duct and used to dilate the passage.
6. If necessary, the duct is irrigated again.
7. The catheter is removed, and an antibiotic is applied to the area.
8. The patient is observed for a brief period and then released.

4. Qualifying circumstances

CPT 68816 is performed on patients with a narrowing or stricture of the nasolacrimal duct. It is important to note that this code should not be reported with codes 68810, 68811, or 68815. If the procedure is performed on both eyes, modifier 50 should be appended to the code, or modifiers LT and RT can be used based on payer preference.

5. When to use CPT code 68816

CPT code 68816 should be used when the provider performs the specific procedure of probing the nasolacrimal duct, with or without irrigation, and includes transluminal balloon catheter dilation. It should not be used for other similar procedures, such as dilation of the lacrimal punctum or probing of lacrimal canaliculi.

6. Documentation requirements

To support a claim for CPT 68816, the provider must document the following information:

• Patient’s diagnosis indicating the need for the procedure
• Details of the procedure performed, including the use of irrigation and transluminal balloon catheter dilation
• Date of the procedure
• Any additional relevant information or findings

7. Billing guidelines

When billing for CPT 68816, ensure that the procedure performed matches the description of the code. It should not be reported with codes 68810, 68811, or 68815. If the procedure is performed on both eyes, modifier 50 or modifiers LT and RT should be appended to the code based on payer preference. It is important to follow payer-specific guidelines for reporting bilateral procedures.

8. Historical information

CPT 68816 was added to the Current Procedural Terminology system on January 1, 2008. There have been no updates to the code since its addition.

9. Examples

1. A provider performs probing of the nasolacrimal duct, with irrigation and transluminal balloon catheter dilation, on a patient with a stricture of the duct.
2. During the procedure, the provider uses a probe to clear the obstruction in the nasolacrimal duct, without irrigation, and performs transluminal balloon catheter dilation.
3. A patient undergoes probing of the nasolacrimal duct, with irrigation and transluminal balloon catheter dilation, on both eyes to correct the narrowing of the duct.
4. The provider performs the procedure of probing the nasolacrimal duct, with irrigation and transluminal balloon catheter dilation, on a patient under general anesthesia.
5. A provider performs the procedure of probing the nasolacrimal duct, with irrigation and transluminal balloon catheter dilation, and inserts a tube or stent to maintain the patency of the duct.
6. During the procedure, the provider probes the nasolacrimal duct, with irrigation and transluminal balloon catheter dilation, and applies an antibiotic to prevent infection.
7. A patient undergoes the procedure of probing the nasolacrimal duct, with irrigation and transluminal balloon catheter dilation, on one eye to correct the narrowing of the duct.
8. The provider performs the procedure of probing the nasolacrimal duct, with irrigation and transluminal balloon catheter dilation, on a pediatric patient with a stricture of the duct.
9. A patient undergoes the procedure of probing the nasolacrimal duct, with irrigation and transluminal balloon catheter dilation, to alleviate symptoms of tearing and discharge.
10. The provider performs the procedure of probing the nasolacrimal duct, with irrigation and transluminal balloon catheter dilation, on a patient with recurrent episodes of dacryocystitis.