CPT 68320 Conjunctival Repair Reimbursement | OpenPayer

Summary & Overview

CPT 68320: Conjunctival Repair/Grafting for Conjunctivochalasis

CPT code 68320 represents surgical repair of the conjunctiva using autologous conjunctival tissue, performed to correct disorders such as conjunctivochalasis. This ophthalmic procedure restores normal conjunctival anatomy to relieve pain, irritation, and tear-film disruption. Nationally, accurate coding of conjunctival repair affects procedural reporting, quality monitoring in ophthalmology, and appropriate facility and professional fee assignment.

Key payers included in this analysis are Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise clinical description, typical sites of service, and commonly applied modifiers. The publication summarizes billing context and coding considerations relevant to surgical ophthalmology practices and facility billing teams.

The piece provides benchmarks and policy-relevant notes where available, clarifies the clinical indications tied to the code, and outlines what information is missing from the input. Data not available in the input includes associated taxonomies, specific ICD-10 diagnoses, related codes, and service-line detail beyond the procedural description.

AetnaBlue Cross Blue ShieldCigna HealthUnitedHealthcareMedicare68320CPTconjunctival repairophthalmologyconjunctivochalasissurgical-procedureambulatory-surgeryeye-surgery

Billing Code Overview

CPT code 68320 describes a surgical repair of the conjunctiva using the patient’s own conjunctival tissue as a graft or by rearranging existing conjunctival tissue. The procedure addresses conditions such as conjunctivochalasis, which involves excess conjunctival folds that can cause irritation, tearing, and pain.

Service type: Surgical ophthalmic procedure — conjunctival repair/grafting

Typical site of service: Ambulatory surgical center or hospital outpatient department; occasionally performed in an ophthalmic specialty clinic with surgical capability

Clinical & Coding Specifications

Clinical Context

A 68-year-old patient presents to an ophthalmology clinic complaining of ocular irritation, foreign body sensation, intermittent tearing, and localized conjunctival folds that worsen with blinking. Slit-lamp examination confirms symptomatic conjunctivochalasis with redundant conjunctival tissue causing tear film disruption and focal keratopathy. After conservative measures (lubrication, topical anti-inflammatories) fail, the ophthalmic surgeon schedules a surgical repair using autologous conjunctival tissue rearrangement or conjunctival autograft to excise and repair the redundant tissue.

The clinical workflow includes preoperative evaluation with ocular history, vision testing, corneal staining, and informed consent. On the day of service, the procedure is performed in an ambulatory surgical center (ASC) or outpatient ophthalmic operating room under local or monitored anesthesia care. The surgeon excises redundant conjunctiva, mobilizes local conjunctival tissue or harvests a conjunctival autograft, and secures it with sutures or tissue adhesive. Postoperative care includes topical antibiotics and steroids, activity restrictions, and follow-up visits for suture removal and assessment of symptom resolution. Typical sites of service are outpatient ophthalmology clinics, ambulatory surgical centers, or hospital outpatient departments.

Coding Specifications

Modifier	Description	When to Use
`25`	Significant, separately identifiable evaluation and management service by the same physician on the day of a procedure

CPT 68335: Symblepharon Repair with Conjunctival or Buccal Graft

CPT-68340-SYMBLEPHARON-REPAIR-CONFORMER-CONTACT-LENS

CPT 68340: Symblepharon Repair Using Conformer or Contact Lens

CPT-68326-CONJUNCTIVAL-REPAIR-CONJUNCTIVAL-GRAFT

CPT 68326: Conjunctival Repair with Graft or Tissue Rearrangement

CPT-68325-CONJUNCTIVAL-REPAIR-BUCCAL-MUCOSAL-GRAFT

CPT 68325: Conjunctival Repair with Buccal Mucosal Graft

CPT-68328-CONJUNCTIVAL-EXCISION-TISSUE-ADHESIVE-GRAFT

CPT 68328: Conjunctival Excision with Tissue Adhesive Graft

CPT-68330-SYMBLEPHARON-REPAIR-CONJUNCTIVOPLASTY-NO-GRAFT

CPT 68330: Symblepharon Repair with Conjunctivoplasty, No Graft

Taxonomy Code	Specialty	Notes
207W00000X	Ophthalmology	Primary specialty performing conjunctival repair procedures.
207WP0000X	Oculoplastic Surgery	Subspecialty managing complex external ocular adnexal and conjunctival reconstruction.
207N00000X	Optometry	May perform pre- and postoperative assessments and nonsurgical management; surgical repair performed by ophthalmologists.
261QA2200X	General Surgery (Ophthalmic service lines)	Occasionally involved in multidisciplinary cases in hospital settings.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`H11.12`	Conjunctivochalasis	Primary diagnosis indicating redundant conjunctival folds causing irritation and tear film disruption; direct indication for surgical repair.
`H10.9`	Conjunctivitis, unspecified	May coexist as an inflammatory process that can mimic or exacerbate conjunctival irritation prompting evaluation.
`H11.3`	Conjunctival cyst	Focal conjunctival pathology that may require excision or modification during conjunctival repair.
`H11.1`	Conjunctival degeneration and deposits	Chronic degenerative changes that can be associated with conjunctival redundancy and symptomatic surface disease.
`H16.222`	Interstitial keratitis, right eye	Corneal surface disease secondary to conjunctival abnormalities causing corneal staining and discomfort; relevant when corneal involvement is present.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`99024`	Postoperative follow-up visit provided during a global period unrelated to a specific E/M service (typically used for routine postoperative visits)	Used for routine postoperative evaluations included or outside the global period following conjunctival repair.
`99070`	Supplies and materials (e.g., surgical gloves, sutures) provided by the physician over and above those usually included with the procedure	Used when reporting additional disposable supplies used during the conjunctival repair.
`66984`	Cataract surgery with intraocular lens implant (complex)	Commonly performed in the same operating session in older patients when cataract surgery is indicated; represents a separate intraocular procedure.
`67800`	Repair of entropion or ectropion; simple, single procedure	Performed for eyelid malposition that may coexist with conjunctival disorders and may be performed concurrently.
`65778`	Conjunctival autograft for pterygium excision; with or without fibrin glue	A related conjunctival autograft technique used in pterygium surgery; technique overlaps with conjunctival grafting methods used in conjunctival repair.

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