Summary & Overview
CPT 68110: Excision of Conjunctival Lesion up to 1 cm
CPT code 68110 represents the surgical excision of a conjunctival lesion up to 1 cm in size, a commonly billed ophthalmic procedure intended to relieve pain, reduce pressure, and often improve vision. As a discrete operative code for conjunctival lesion removal, 68110 is used across outpatient surgical settings nationally and has implications for coding accuracy, reimbursement consistency, and clinical documentation standards.
Key payers covered in this analysis include Aetna, Blue Cross Blue Shield, Cigna, UnitedHealthcare, and Medicare. Readers will find a concise overview of the clinical context for the procedure, typical sites of service, and the most relevant billing considerations. The publication summarizes national benchmarking and payer contract patterns where available, outlines common documentation elements that support medical necessity, and highlights related coding and billing practices that affect claim adjudication.
This report is intended for coding managers, revenue cycle professionals, ophthalmology clinicians, and policy analysts seeking a clear, national-level view of how CPT code 68110 is defined and applied. Data not available in the input are noted where applicable.
Billing Code Overview
CPT code 68110 describes the excision of a conjunctival lesion up to 1 cm in greatest dimension. This procedure is performed to relieve pain and pressure from the lesion and often to improve vision.
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Service type: Surgical excision of conjunctival lesion
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Typical site of service: Ambulatory surgical center or hospital outpatient setting; may also be performed in an ophthalmology office procedure room when appropriate
Clinical & Coding Specifications
Clinical Context
A typical patient is an adult who presents to an ophthalmology clinic with a symptomatic conjunctival lesion such as a pterygium, conjunctival nevus, or localized conjunctival scarring causing ocular irritation, foreign-body sensation, pain, tearing, or visual axis encroachment. The procedure 68110 is performed in an ambulatory surgery center or hospital outpatient setting, and occasionally in an office procedure room when appropriate sterile conditions and anesthesia are available. Preoperative workflow includes history and medication review, informed consent, topical or local anesthesia with or without sedation, and surgical site preparation. The surgeon excises the conjunctival lesion up to 1 cm, controls hemostasis, and closes or allows healing by secondary intention depending on size and location. Postoperative workflow includes application of antibiotic and anti-inflammatory drops or ointment, discharge instructions, scheduling of a follow-up visit within 1 week to assess healing and monitor for recurrence or complications, and documentation of lesion size, laterality, anesthesia, and any intraoperative findings.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
26 | Professional component | Use when billing only the physician professional component separate from facility technical component. |