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The procedure described by CPT® Code 68520 refers to the excision of the lacrimal sac, commonly known as dacryocystectomy. This surgical intervention is performed to address issues related to the lacrimal system, which is responsible for tear drainage. The lacrimal sac is a key component of this system, located at the inner corner of the eye, and is connected to the nasolacrimal duct that drains tears into the nasal cavity. During the procedure, the area surrounding the eye is first cleansed to minimize the risk of infection. A local anesthetic is then administered subcutaneously around the lacrimal sac to ensure the patient remains comfortable and pain-free throughout the surgery. An incision is made over the inner aspect of the lower eyelid, allowing the surgeon to access the lacrimal sac, nasolacrimal duct, and canaliculi, which are small channels that carry tears from the eye to the lacrimal sac. The excision of the lacrimal sac involves carefully removing it from its surrounding tissues. Following the excision, the proximal end of the nasolacrimal duct is cauterized to prevent bleeding and to promote healing. The canaliculi are also probed to assess their patency; if either the superior or inferior canaliculus is found to be open, they are cauterized as well. In cases where a fistula, or abnormal connection, is present, it is excised during the procedure. Finally, the surgical wound is closed, and a dressing is applied to protect the area as it heals.
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The dacryocystectomy procedure, represented by CPT® Code 68520, is indicated for various conditions affecting the lacrimal system. These indications may include:
The dacryocystectomy procedure involves several critical steps to ensure successful excision of the lacrimal sac and associated structures. The steps are as follows:
After the dacryocystectomy procedure, patients can expect specific post-operative care and considerations. It is important to monitor the surgical site for any signs of infection or complications. Patients may experience some swelling and discomfort, which can be managed with prescribed pain relief medications. Follow-up appointments are typically scheduled to assess healing and ensure that the lacrimal system is functioning properly. Patients should be advised to avoid strenuous activities and to keep the area clean and dry during the initial recovery period. Any unusual symptoms, such as excessive bleeding or persistent pain, should be reported to the healthcare provider promptly for further evaluation.
| Short Descr | REMOVAL OF TEAR SAC | Medium Descr | EXCISION LACRIMAL SAC | Long Descr | Excision of lacrimal sac (dacryocystectomy) | 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 |
| 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). | 54 | Surgical care only: when 1 physician or other qualified health care professional performs a surgical procedure and another provides preoperative and/or postoperative management, surgical services may be identified by adding modifier 54 to the usual procedure number. | 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). | 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 | XS | Separate structure, a service that is distinct because it was performed on a separate organ/structure |
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| Pre-1990 | Added | Code added. |
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