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Conjunctivoplasty with reconstruction of the cul-de-sac is a surgical procedure aimed at addressing various conditions affecting the conjunctiva, which is the thin, transparent membrane covering the white part of the eye and the inner surface of the eyelids. This procedure is particularly relevant for patients experiencing issues such as redundant conjunctiva, lesions on the conjunctiva, or hyperemia, which is the increased blood flow leading to redness of the conjunctival blood vessels. The cul-de-sac, also known as the conjunctival fornix, is the anatomical area where the conjunctiva of the eyeball meets that of the eyelid, playing a crucial role in the overall function and health of the eye. During the procedure, a subconjunctival injection may be administered to elevate the conjunctiva away from the sclera, allowing for better access to the affected area. The surgeon will then excise any redundant or abnormal conjunctival tissue. Depending on the specific case, the remaining conjunctiva may be rearranged, or a conjunctival graft may be harvested from the contralateral eye to repair the defect, including the cul-de-sac area. If a conjunctival graft is utilized, the donor site is carefully marked, and the conjunctiva is elevated using a combination of a subconjunctival injection of balanced salt solution and local anesthetic. The graft is meticulously excised and prepared for placement over the defect in the conjunctiva of the opposite eye. In the case of CPT® Code 68328, a buccal mucous membrane graft, typically harvested from the lower lip, is employed to repair the conjunctival defect, ensuring that the graft is appropriately sized and shaped to fit the surgical site. This comprehensive approach aims to restore the integrity and function of the conjunctiva and cul-de-sac, ultimately improving patient outcomes.
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The procedure of conjunctivoplasty with reconstruction of the cul-de-sac is indicated for a variety of conditions affecting the conjunctiva. These include:
The conjunctivoplasty procedure involves several detailed steps to ensure effective reconstruction of the cul-de-sac. These steps include:
Post-procedure care for conjunctivoplasty with buccal mucous membrane graft involves monitoring the surgical site for signs of infection or complications. Patients may be advised to avoid strenuous activities and to follow specific eye care instructions to promote healing. The recovery process may vary depending on the individual, but generally, patients can expect some degree of discomfort, which can be managed with prescribed medications. Follow-up appointments are essential to assess the healing process and ensure the success of the graft.
| Short Descr | REVISE/GRAFT EYELID LINING | Medium Descr | CONJUNCTPL CUL-DE-SAC W/BUCCAL MUC MEMB GRAFT | Long Descr | Conjunctivoplasty, reconstruction cul-de-sac; with buccal mucous membrane graft (includes obtaining graft) | 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) | 0 - 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 |
| 22 | Increased procedural services: when the work required to provide a service is substantially greater than typically required, it may be identified by adding modifier 22 to the usual procedure code. documentation must support the substantial additional work and the reason for the additional work (ie, increased intensity, time, technical difficulty of procedure, severity of patient's condition, physical and mental effort required). note: this modifier should not be appended to an e/m service. | 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). | 58 | Staged or related procedure or service by the same physician or other qualified health care professional during the postoperative period: it may be necessary to indicate that the performance of a procedure or service during the postoperative period was: (a) planned or anticipated (staged); (b) more extensive than the original procedure; or (c) for therapy following a surgical procedure. this circumstance may be reported by adding modifier 58 to the staged or related procedure. note: for treatment of a problem that requires a return to the operating/procedure room (eg, unanticipated clinical condition), see modifier 78. | 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.) | 82 | Assistant surgeon (when qualified resident surgeon not available): the unavailability of a qualified resident surgeon is a prerequisite for use of modifier 82 appended to the usual procedure code number(s). | 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 | 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 |
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| Pre-1990 | Added | Code added. |
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