Summary & Overview
CPT 68326: Conjunctival Repair with Graft or Tissue Rearrangement
CPT code 68326 represents surgical repair of the conjunctiva at the conjunctival margin where the tissue covering the eyeball meets the eyelid, using the patient’s own conjunctival tissue as a graft or by rearranging existing tissue. This ophthalmic procedure code matters nationally because it defines coverage and billing for common conjunctival reconstructions following trauma, pterygium-related surgery complications, or other conjunctival defects that affect ocular surface health and patient comfort.
Key payers in national coverage discussions include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise overview of clinical context for conjunctival repair, typical service settings (hospital outpatient departments, ambulatory surgical centers, and ophthalmic surgical offices), and which payers are commonly responsible for reimbursement. The publication also outlines typical modifiers and related billing considerations when available, and highlights where input data is not provided.
This summary equips clinicians, coding professionals, and policy analysts with the code purpose, where the service is commonly delivered, and which major payers are relevant for national billing considerations. Data not available in the input is clearly noted and not inferred.
Billing Code Overview
CPT code 68326 describes a surgical repair of the conjunctiva at the conjunctival-lid/eyeball junction, performed using the patient’s own conjunctival tissue either as a graft or by rearranging existing conjunctival tissue. This code covers procedures that restore the integrity and position of the conjunctival tissue where it meets the eyelid and globe.
Service Type: Ophthalmic surgical procedure — conjunctival repair/grafting
Typical Site of Service: Hospital outpatient department, ambulatory surgical center, or ophthalmologist's office with surgical capability
Data not available in the input.
Clinical & Coding Specifications
Clinical Context
A 58-year-old patient presents to the ophthalmology clinic with progressive conjunctival scarring and symptomatic conjunctival defect at the limbus after prior pterygium excision on the right eye. The patient reports foreign body sensation, tearing, and localized discomfort that is worse with blinking. Slit-lamp exam confirms conjunctival defect with adjacent conjunctival contraction and exposure of underlying sclera. Conservative measures (lubrication, anti-inflammatory drops) have failed to restore comfort or prevent recurrent fibrosis.
The clinical workflow begins with preoperative evaluation including focused ocular history, visual acuity, external examination, slit-lamp biomicroscopy, and photographic documentation. Informed consent documents the planned surgical repair of the conjunctiva with autograft versus conjunctival transposition. On the day of surgery the surgeon performs regional anesthesia or monitored anesthesia care, prepares the ocular surface, debrides scar tissue, and fashions a conjunctival autograft or repositions local conjunctiva to repair the defect. Hemostasis is achieved, and the graft is secured with sutures or tissue adhesive. Postoperative instructions include topical antibiotic and steroid drops, activity restrictions, and follow-up at postoperative day 1, week 1, and week 4 to monitor healing and graft incorporation. Billing uses 68326 for the conjunctival repair with conjunctival autograft or rearrangement; appropriate modifiers are appended as indicated by laterality, professional component, and circumstances of care.
Coding Specifications
| Modifier | Description | When to Use |
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