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The CPT® Code 68130 refers to the excision of a lesion located on the conjunctiva, which is the clear membrane covering the white part of the eye, along with adjacent scleral tissue. This procedure is typically indicated for various types of conjunctival lesions, including benign conditions such as squamous cell and limbal papillomas, as well as malignant conditions like primary acquired melanosis, conjunctival melanoma, and squamous cell carcinoma. During the procedure, local anesthesia is administered, often in the form of anesthetic drops, to ensure patient comfort. The surgeon inspects the conjunctiva to assess the lesion and determine the extent of the excision required. The excision involves removing the lesion along with a margin of healthy tissue to ensure that all abnormal cells are removed. The excised tissue is then sent for pathological evaluation to confirm the diagnosis and to check that the margins are clear of any remaining disease. If necessary, additional tissue, including scleral tissue, may be excised until clear margins are achieved. This code is specifically used when the excision involves adjacent scleral tissue, distinguishing it from other codes that apply to smaller conjunctival lesions without scleral involvement.
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The procedure associated with CPT® Code 68130 is indicated for the excision of conjunctival lesions that may present as benign or malignant conditions. The following are specific indications for this procedure:
The procedure for excising a conjunctival lesion with adjacent sclera involves several critical steps, which are outlined below:
After the excision procedure, the patient may require specific post-operative care to promote healing and monitor for any complications. This may include instructions on how to care for the surgical site, the use of prescribed medications such as topical antibiotics or anti-inflammatory drops, and follow-up appointments to assess healing and pathology results. Patients should be advised to avoid rubbing or putting pressure on the eye and to report any signs of infection or unusual symptoms to their healthcare provider promptly. The expected recovery time may vary depending on the extent of the excision and the individual patient's healing process.
| Short Descr | EXC LES CONJUNCTIVA ADJ SCL | Medium Descr | EXCISION LESION CONJUNCTIVA ADJACENT SCLERA | Long Descr | Excision of lesion, conjunctiva; with adjacent sclera | Status Code | Active Code | Global Days | 090 - Major Surgery | PC/TC Indicator (26, TC) | 0 - Physician Service Code | Multiple Procedures (51) | 2 - Standard payment adjustment rules for multiple procedures apply. | Bilateral Surgery (50) | 1 - 150% payment adjustment for bilateral procedures applies. | Physician Supervisions | 09 - Concept does not apply. | Assistant Surgeon (80, 82) | 1 - Statutory payment restriction for assistants at surgery applies to this procedure... | Co-Surgeons (62) | 0 - Co-surgeons not permitted for this procedure. | Team Surgery (66) | 0 - Team surgeons not permitted for this procedure. | Diagnostic Imaging Family | 99 - Concept Does Not Apply | APC Status Indicator | Hospital Part B services paid through a comprehensive APC | ASC Payment Indicator | Surgical procedure on ASC list in CY 2007; payment based on OPPS relative payment weight. | Type of Service (TOS) | 2 - Surgery | Berenson-Eggers TOS (BETOS) | P4E - Eye procedure - other | MUE | 1 | CCS Clinical Classification | 19 - Other therapeutic procedures on eyelids, conjunctiva, cornea |
| 50 | Bilateral procedure: unless otherwise identified in the listings, bilateral procedures that are performed at the same session, should be identified by adding modifier 50 to the appropriate 5 digit code. note: this modifier should not be appended to designated "add-on" codes (see appendix d). | 51 | Multiple procedures: when multiple procedures, other than e/m services, physical medicine and rehabilitation services or provision of supplies (eg, vaccines), are performed at the same session by the same individual, the primary procedure or service may be reported as listed. the additional procedure(s) or service(s) may be identified by appending modifier 51 to the additional procedure or service code(s). note: this modifier should not be appended to designated "add-on" codes (see appendix d). | 59 | Distinct procedural service: under certain circumstances, it may be necessary to indicate that a procedure or service was distinct or independent from other non-e/m services performed on the same day. modifier 59 is used to identify procedures/services, other than e/m services, that are not normally reported together, but are appropriate under the circumstances. documentation must support a different session, different procedure or surgery, different site or organ system, separate incision/excision, separate lesion, or separate injury (or area of injury in extensive injuries) not ordinarily encountered or performed on the same day by the same individual. however, when another already established modifier is appropriate it should be used rather than modifier 59. only if no more descriptive modifier is available, and the use of modifier 59 best explains the circumstances, should modifier 59 be used. note: modifier 59 should not be appended to an e/m service. to report a separate and distinct e/m service with a non-e/m service performed on the same date, see modifier 25. | 79 | Unrelated procedure or service by the same physician or other qualified health care professional during the postoperative period: the individual may need to indicate that the performance of a procedure or service during the postoperative period was unrelated to the original procedure. this circumstance may be reported by using modifier 79. (for repeat procedures on the same day, see modifier 76.) | E1 | Upper left, eyelid | E2 | Lower left, eyelid | E3 | Upper right, eyelid | E4 | Lower right, eyelid | GC | This service has been performed in part by a resident under the direction of a teaching physician | GW | Service not related to the hospice patient's terminal condition | LT | Left side (used to identify procedures performed on the left side of the body) | RT | Right side (used to identify procedures performed on the right side of the body) | SG | Ambulatory surgical center (asc) facility service | XU | Unusual non-overlapping service, the use of a service that is distinct because it does not overlap usual components of the main service |
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| 2025-01-01 | Changed | Short Description changed. |
| Pre-1990 | Added | Code added. |
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