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The procedure described by CPT® Code 68420 involves the incision and drainage of the lacrimal sac, a treatment commonly referred to as dacryocystotomy or dacryocystostomy. This procedure is indicated when there is an abscess or an accumulation of fluid within the lacrimal sac, which can lead to discomfort and potential complications if not addressed. The lacrimal sac is a part of the tear drainage system, and when it becomes obstructed or infected, it can result in significant swelling and pain. During the procedure, the inner aspect of the lower eyelid is prepared by cleansing the area, and a local anesthetic is administered to minimize discomfort for the patient. A stab incision is then made directly over the area where fluid accumulation is noted, allowing for effective drainage of the fluid. This intervention is crucial for alleviating symptoms and preventing further complications associated with lacrimal sac disorders.
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The procedure described by CPT® Code 68420 is indicated for the following conditions:
The procedure for CPT® Code 68420 involves several key steps to ensure effective drainage of the lacrimal sac. First, the inner aspect of the lower eyelid is thoroughly cleansed to reduce the risk of infection. Following this, a local anesthetic is administered as needed to ensure the patient experiences minimal discomfort during the procedure. Once the area is adequately prepared, a stab incision is made directly over the site of fluctuance, which is the area where fluid accumulation is observed. This incision allows for the drainage of the accumulated fluid, relieving pressure and discomfort. The surgeon may also assess the area for any loculations, which are pockets of fluid that may require further intervention. The procedure is designed to be efficient and effective, providing immediate relief from the symptoms associated with lacrimal sac issues.
After the completion of the incision and drainage procedure, patients may be monitored for any immediate complications. It is important to observe the site for signs of infection or excessive bleeding. Depending on the extent of the drainage and the surgeon's assessment, the incision may be left open to allow for continued drainage, or a drain may be placed to facilitate further fluid removal. Patients are typically advised on post-procedure care, which may include keeping the area clean and dry, applying prescribed topical antibiotics, and following up with their healthcare provider to ensure proper healing and to address any ongoing symptoms.
| Short Descr | I&D LACRIMAL SAC | Medium Descr | INCISION&DRAINAGE LACRIMAL SAC | Long Descr | Incision, drainage of lacrimal sac (dacryocystotomy or dacryocystostomy) | Status Code | Active Code | Global Days | 010 - Minor Procedure | 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 | Office-based surgical procedure added to ASC list in CY 2008 or later with MPFS nonfacility PE RVUs; payment based on MPFS nonfacility PE RVUs. | Type of Service (TOS) | 2 - Surgery | Berenson-Eggers TOS (BETOS) | P6C - Minor procedures - other (Medicare fee schedule) | MUE | 1 | CCS Clinical Classification | 19 - Other therapeutic procedures on eyelids, conjunctiva, cornea |
| 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.) | 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. | 76 | Repeat procedure or service by same physician or other qualified health care professional: it may be necessary to indicate that a procedure or service was repeated by the same physician or other qualified health care professional subsequent to the original procedure or service. this circumstance may be reported by adding modifier 76 to the repeated procedure or service. note: this modifier should not be appended to an e/m service. | AQ | Physician providing a service in an unlisted health professional shortage area (hpsa) | 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 |
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| 2025-01-01 | Changed | Short and Medium Descriptions changed. |
| Pre-1990 | Added | Code added. |
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