Summary & Overview
CPT 68420: Incision of Lacrimal Sac (Tear Duct) to Treat Obstruction
CPT code 68420 represents a surgical incision of the lacrimal sac (tear duct) to treat narrowing or obstruction that can cause dry eye and related symptoms. Nationally, procedures that restore lacrimal drainage are clinically important because they address persistent epiphora, recurrent infections, and quality-of-life impacts tied to tear drainage dysfunction. The code captures a focused, site-specific intervention commonly performed by ophthalmic plastic surgeons and otolaryngologists.
Key payers discussed include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. The publication outlines coverage patterns, common billing modifiers, and where available, reimbursement benchmarks used by these major payers. It also situates the procedure in clinical context: indications, typical settings, and how this code fits into surgical care pathways for lacrimal obstruction.
Readers will learn the clinical definition and typical sites of service for CPT code 68420, which payers are included in the analysis, and what components of billing and policy are relevant for this procedure. Data not available in the input is noted where applicable, and the piece focuses on national-level implications for coding and clinical billing practices.
Billing Code Overview
CPT code 68420 describes a surgical procedure in which the provider incises the lacrimal sac (tear duct) to treat narrowing or obstruction that contributes to dry eye. This procedure is an incision of the lacrimal sac performed to restore tear drainage and relieve symptoms related to obstruction.
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Service type: Surgical procedure to address lacrimal drainage obstruction
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Typical site of service: Ophthalmology or otolaryngology surgical suite, ambulatory surgery center, or hospital operating room
Clinical & Coding Specifications
Clinical Context
A 64-year-old female presents to the ophthalmology clinic with a 6‑month history of chronic tearing, recurrent dacryocystitis, and intermittent mucopurulent discharge from the medial canthal region of the right eye. Conservative management with topical antibiotics and lacrimal sac massage provided only transient relief. Dacryocystography and lacrimal irrigation demonstrate a distal nasolacrimal duct obstruction. After preoperative evaluation, the ophthalmic surgeon schedules a dacryocystotomy to directly incise the lacrimal sac and restore lacrimal drainage.
The clinical workflow includes preoperative history and physical, informed consent documenting indication and alternatives, local or general anesthesia per patient factors, procedural incision of the lacrimal sac (external or transconjunctival approach), intraoperative irrigation to confirm patency, placement of temporary silicone stent if indicated, postoperative antibiotics and topical care, and scheduled follow-up to assess drainage and wound healing. Typical site of service is an ambulatory surgery center or hospital outpatient department. The service type is surgical — lacrimal sac incision for obstruction (Dacryocystotomy).
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
00 | Unspecified | Rarely used; reserve per payer rules when no specific modifier applies |