Summary & Overview
CPT 68340: Symblepharon Repair Using Conformer or Contact Lens
CPT code 68340 represents a targeted ocular reconstructive procedure to repair a symblepharon with the use of a conformer or contact lens to restore ocular surface anatomy and improve vision. Nationally, this code captures a specialized ophthalmic service typically performed in ambulatory surgical centers or hospital outpatient departments and is relevant for surgical ophthalmology practices and payers managing vision-restorative interventions.
Key payers covered in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise overview of clinical context for the procedure, typical sites of service, and common billing considerations. The publication highlights benchmarks where available, summarizes relevant billing modifiers and payer coverage patterns, and outlines areas for coding clarity and policy updates affecting reimbursement and claims adjudication.
This summary serves clinicians, coding specialists, and payer policy teams seeking a national-level brief on the purpose and billing context of CPT code 68340, the populations it serves, and the practical coding and administrative considerations that often accompany surgical repair of symblepharon.
Billing Code Overview
CPT code 68340 describes a surgical procedure to repair a symblepharon using a conformer or contact lens to improve a patient's vision. This procedure is performed to release adhesions between the eyelid conjunctiva and the bulbar conjunctiva that limit ocular surface mobility and visual function.
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Service type: Ocular reconstructive procedure to repair symblepharon using a conformer or contact lens
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Typical site of service: Ambulatory surgical center or hospital outpatient department, depending on patient complexity and anesthesia needs
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Clinical & Coding Specifications
Clinical Context
A 56-year-old patient presents to an ophthalmology clinic with progressive vision distortion and ocular surface discomfort after a chemical burn to the eye six months prior. Clinical exam demonstrates a symblepharon with adhesion between the palpebral conjunctiva and bulbar conjunctiva that limits ocular motility and obscures the visual axis. Conservative management has failed. The surgical plan is to perform symblepharon lysis and reconstruction using a conformer or therapeutic contact lens to maintain fornix depth and prevent re-adhesion, with the goal of improving corneal exposure and visual function. The typical workflow includes preoperative assessment in the clinic, informed consent, operating room (or ambulatory surgery center) procedure under monitored anesthesia care or local/regional block with sedation, intraoperative excision of fibrous adhesions, placement of a conformer or specialty contact lens to maintain conjunctival apposition and fornix contour, possible grafting if needed, postoperative topical antibiotic and steroid therapy, and scheduled follow-up visits to monitor healing and remove or exchange the conformer/contact lens as indicated.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
22 | Increased procedural services | Use when work, time, and complexity substantially exceed usual for 68340 (document rationale). |