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Official Description

Excision of lacrimal gland tumor; frontal approach

© Copyright 2026 American Medical Association. All rights reserved.

Common Language Description

The excision of a lacrimal gland tumor, as described by CPT® Code 68540, involves the surgical removal of a tumor located in the lacrimal gland, which is responsible for tear production. This gland is situated in the superotemporal region of the orbit and consists of two lobes: the larger orbital lobe and the smaller palpebral lobe. The orbital lobe is positioned behind the orbital bone and is not visible during a standard external eye examination, while the palpebral lobe can be identified when the eyelid is everted. Tumors in the lacrimal gland can arise from various conditions, including inflammatory processes such as dacryoadenitis and sarcoidosis, as well as neoplastic changes, which can be benign or malignant. Benign tumors may include pleomorphic adenomas and oncocytomas, whereas malignant tumors can consist of adenoid cystic carcinoma and squamous cell carcinoma, among others. The procedure typically employs a frontal approach, where an incision is made along the crease of the upper eyelid to access the gland. The surgical technique involves careful dissection to expose the lacrimal gland, followed by its excision. Pathological evaluation of frozen sections is performed to ensure that the tumor margins are clear of cancerous cells, and if necessary, additional surrounding tissue may be removed to achieve clean margins. The surgical site is then closed in layers to promote proper healing.

© Copyright 2026 Coding Ahead. All rights reserved.

1. Indications

The excision of a lacrimal gland tumor is indicated for various conditions affecting the lacrimal gland, particularly when a tumor is suspected or confirmed. The following are specific indications for this procedure:

  • Inflammatory Lesions These may include conditions such as dacryoadenitis, sarcoidosis, and orbital inflammatory pseudotumor, which can cause swelling and dysfunction of the lacrimal gland.
  • Benign Neoplastic Lesions Tumors such as pleomorphic adenoma, benign reactive lymphoid hyperplasia, and oncocytomas may necessitate excision to alleviate symptoms or prevent complications.
  • Malignant Neoplastic Lesions The presence of malignant tumors, including adenoid cystic carcinoma, squamous cell carcinoma, adenocarcinoma, mucoepidermoid carcinoma, and malignant lymphomas, requires surgical intervention to remove cancerous tissue and prevent further spread.

2. Procedure

The procedure for excising a lacrimal gland tumor using CPT® Code 68540 involves several critical steps, which are detailed as follows:

  • Step 1: Anesthesia and Preparation The patient is positioned appropriately, and local anesthesia is administered to ensure comfort during the procedure. The surgical area is then prepared and draped to maintain a sterile environment.
  • Step 2: Incision A skin incision is made along the natural crease of the upper eyelid. This approach minimizes visible scarring and provides access to the lacrimal gland.
  • Step 3: Dissection The soft tissues surrounding the lacrimal gland are carefully dissected to expose the gland. This step requires precision to avoid damaging surrounding structures.
  • Step 4: Excision of the Lacrimal Gland Once the lacrimal gland is fully exposed, it is meticulously dissected free from the surrounding tissues and excised. This step is crucial for ensuring complete removal of the tumor.
  • Step 5: Pathological Evaluation Frozen sections of the excised tissue are sent to a pathologist for evaluation. This assessment determines whether the margins of the excised tissue are clear of cancerous cells.
  • Step 6: Additional Tissue Removal (if necessary) If the margins are found to be not clean, additional surrounding tissue is excised until clear margins are achieved, ensuring that all cancerous cells are removed.
  • Step 7: Closure The surgical wound is closed in layers, typically starting with the deeper tissues and finishing with the skin, to promote optimal healing and minimize complications.

3. Post-Procedure

After the excision of the lacrimal gland tumor, patients are monitored for any immediate complications. Post-procedure care may include instructions for wound care, pain management, and follow-up appointments to assess healing and evaluate pathology results. Patients may experience swelling and bruising around the surgical site, which is expected and typically resolves over time. It is essential to follow the surgeon's recommendations regarding activity restrictions and signs of potential complications, such as infection or excessive bleeding, that should prompt immediate medical attention.

Short Descr REMOVE TEAR GLAND LESION
Medium Descr EXC LACRIMAL GLAND TUMOR FRONTAL APPROACH
Long Descr Excision of lacrimal gland tumor; frontal approach
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) 1 - Co-surgeons could be paid, though supporting documentation is required...
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).
52 Reduced services: under certain circumstances a service or procedure is partially reduced or eliminated at the discretion of the physician or other qualified health care professional. under these circumstances the service provided can be identified by its usual procedure number and the addition of modifier 52, signifying that the service is reduced. this provides a means of reporting reduced services without disturbing the identification of the basic service. note: for hospital outpatient reporting of a previously scheduled procedure/service that is partially reduced or cancelled as a result of extenuating circumstances or those that threaten the well-being of the patient prior to or after administration of anesthesia, see modifiers 73 and 74 (see modifiers approved for asc hospital outpatient use).
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.
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)
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