Summary & Overview
CPT 68500: Lacrimal Gland Excision for Excessive Tearing
CPT code 68500 denotes surgical excision of the lacrimal gland to address excessive tearing that has produced dry eye. The procedure is an ophthalmic surgical service used when gland removal is clinically indicated to reduce epiphora and its sequelae. Nationally, this code is relevant for surgeons, hospital and ambulatory surgery centers, and payers because it implicates operative setting, post‑operative care, and ocular surface management.
Key payers considered include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise overview of the code’s clinical purpose, typical sites of service, and the payer landscape that affects coverage and billing. The publication provides benchmarks where available, notes on common billing modifiers, and context for clinical documentation tied to lacrimal gland excision. It also outlines policy considerations relevant to reimbursement coding, utilization review, and prior authorization trends for ophthalmic surgical procedures.
This summary serves clinicians, coding specialists, and revenue cycle professionals seeking a national perspective on CPT code 68500, including practical information to support accurate coding and administrative planning.
Billing Code Overview
CPT code 68500 describes the surgical removal of the lacrimal gland performed to treat excessive tearing that results in dry eye. This procedure involves excision of the lacrimal gland tissue when gland dysfunction or hypersecretion contributes to symptomatic epiphora and associated ocular surface symptoms.
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Service type: Surgical excision of lacrimal gland
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Typical site of service: Ambulatory surgical center or hospital operating room
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Clinical & Coding Specifications
Clinical Context
A 45-year-old female presents to oculoplastic surgery with chronic, refractory epiphora of the left eye causing social embarrassment and recurrent conjunctival irritation. Prior conservative measures including topical lubrication, punctal plugs, and lacrimal irrigation were ineffective. Clinical exam and imaging localize the problem to a hypersecreting or obstructive lacrimal gland with secondary wetting of the ocular surface. After preoperative evaluation and informed consent, the patient is scheduled for surgical excision of the lacrimal gland under monitored anesthesia care or general anesthesia in an ambulatory surgery center. The clinical workflow includes preoperative history and medication reconciliation, marking laterality, obtaining baseline ocular surface and vision documentation, intraoperative removal of the lacrimal gland with hemostasis and tissue sent to pathology when indicated, application of appropriate modifiers for billing (for example laterality LT), postoperative instructions for lubricants and wound care, and follow-up visits to assess tear production, wound healing, and ocular surface status.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
LT | Left side | Use when the procedure is performed on the left lacrimal gland |