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Official Description

Excision of lacrimal sac (dacryocystectomy)

© Copyright 2026 American Medical Association. All rights reserved.

Common Language Description

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.

© Copyright 2026 Coding Ahead. All rights reserved.

1. Indications

The dacryocystectomy procedure, represented by CPT® Code 68520, is indicated for various conditions affecting the lacrimal system. These indications may include:

  • Chronic dacryocystitis - A persistent inflammation of the lacrimal sac, often due to obstruction of the nasolacrimal duct.
  • Lacrimal sac tumors - The presence of benign or malignant growths within the lacrimal sac that necessitate surgical removal.
  • Fistula formation - The development of abnormal connections between the lacrimal sac and surrounding tissues, which may require excision.
  • Obstruction of the nasolacrimal duct - Blockages that prevent normal tear drainage, leading to excessive tearing or infection.

2. Procedure

The dacryocystectomy procedure involves several critical steps to ensure successful excision of the lacrimal sac and associated structures. The steps are as follows:

  • Step 1: Preparation - The skin around the eye is thoroughly cleansed to reduce the risk of infection. This step is crucial for maintaining a sterile environment during the surgery.
  • Step 2: Anesthesia - A local anesthetic is injected subcutaneously around the lacrimal sac. This ensures that the patient remains comfortable and pain-free throughout the procedure, allowing for a more effective surgical intervention.
  • Step 3: Incision - An incision is made over the inner aspect of the lower eyelid. This strategic location provides optimal access to the lacrimal sac, nasolacrimal duct, and canaliculi.
  • Step 4: Exposure - The lacrimal sac, nasolacrimal duct, and canaliculi are carefully exposed. This step requires precision to avoid damaging surrounding tissues.
  • Step 5: Excision - The lacrimal sac is excised from its surrounding structures. This is a critical step in the procedure, as it addresses the underlying issues affecting the lacrimal system.
  • Step 6: Cauterization - The proximal end of the nasolacrimal duct is cauterized to prevent bleeding and promote healing. This step is essential for ensuring a successful outcome.
  • Step 7: Canaliculus Assessment - The canaliculi are probed to determine their patency. If either the superior or inferior canaliculus is found to be patent, they are cauterized to prevent future complications.
  • Step 8: Fistula Excision - If a fistula is present, it is excised during this step to eliminate any abnormal connections that may interfere with normal tear drainage.
  • Step 9: Closure - The surgical wound is closed, ensuring that the incision site is properly secured for optimal healing.
  • Step 10: Dressing Application - A dressing is applied to the area to protect the surgical site and support the healing process.

3. Post-Procedure

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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