Summary & Overview
CPT 68510: Lacrimal Gland Biopsy with Specimen for Pathology
CPT code 68510 covers a diagnostic surgical biopsy of the lacrimal gland with submission of the specimen for pathologic examination. This procedure provides tissue diagnosis for inflammatory, infectious, and neoplastic conditions affecting the lacrimal gland and adjacent orbital structures. Nationally, accurate coding and documentation for lacrimal gland biopsy matter for clinical communication, utilization tracking, and appropriate billing across diverse payer policies. Key payers included in this analysis are Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare.
Readers will find a concise overview of the clinical context for lacrimal gland biopsy, expected sites of service, and the common modifiers associated with procedural reporting. The publication summarizes typical coverage considerations and coding practice patterns, presents benchmark metrics where available, and highlights recent policy updates affecting hospital outpatient and ambulatory surgical settings. The content is intended to help revenue cycle and clinical teams understand the coding intent, documentation needs, and payer landscape relevant to CPT code 68510 at a national level.
Billing Code Overview
CPT code 68510 describes a procedure in which a provider performs a biopsy of the lacrimal gland and submits the tissue specimen to a laboratory for pathologic examination. The service is a diagnostic surgical procedure aimed at obtaining tissue to establish or rule out ocular and orbital disease processes.
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Service type: Diagnostic surgical biopsy
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Typical site of service: Ambulatory surgical center or hospital outpatient department; may also be performed in an office setting with appropriate surgical capability
Clinical & Coding Specifications
Clinical Context
A typical patient is an adult presenting to an ophthalmology or oculoplastic clinic with a persistent, enlarging, or suspicious lacrimal gland mass causing eyelid fullness, localized pain, dacryoadenitis, or unexplained tearing. Imaging (orbital CT or MRI) identifies a discrete lacrimal gland lesion. After discussion of indications, risks, and alternatives, the oculoplastic surgeon schedules a lacrimal gland biopsy to obtain tissue for histopathology and culture.
Preoperative workflow includes history, focused ophthalmic exam, and imaging review. On the day of service, the patient receives local anesthesia with or without monitored anesthesia care; an external eyelid crease or lateral orbit approach is used. The provider obtains a targeted incisional or excisional biopsy of the lacrimal gland and submits the specimen to the pathology laboratory with appropriate labeling and requisition. Postprocedure includes specimen handling documentation, postoperative instructions, and arrangement for pathology results and possible further management based on diagnosis (e.g., inflammatory disease, lymphoma, carcinoma, or nonspecific chronic dacryoadenitis). Typical site of service is an outpatient ambulatory surgery center or hospital outpatient department; minor procedures may occur in an office procedure room if facility and staff support pathology submission and sterile technique.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
26 | Professional component |