Summary & Overview
CPT 68530: Removal of Dacryolith or Foreign Body from Lacrimal Gland or Sac
CPT code 68530 denotes surgical removal of a foreign body or dacryolith from the lacrimal gland or sac to relieve obstruction of the tear duct. As a targeted ophthalmic surgical procedure, it is used to restore tear drainage, reduce recurrent infections, and resolve chronic tearing that can impair vision and quality of life. Nationally, this code represents a niche but clinically important intervention performed by ophthalmologists and oculoplastic surgeons.
Key payers included in this analysis are Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare and Medicare. Readers will find a concise clinical context for the procedure, typical sites of service, and which payer types commonly cover such surgical lacrimal procedures. The publication outlines billing considerations relevant to surgical services, common modifiers used in practice, and where this code sits in relation to other lacrimal and ophthalmic surgical codes.
This summary equips billing managers, compliance officers, and clinical leaders with an overview of CPT code 68530, its clinical intent, and the payer landscape. It highlights what to expect when preparing claims and documentation for lacrimal duct or sac foreign body removal and points readers toward detailed sections on benchmarks, coding guidance, and clinical indications.
Billing Code Overview
CPT code 68530 describes the surgical removal of a foreign body or dacryolith (stone) from the lacrimal gland or lacrimal sac to treat obstruction or blockage of the tear duct. This procedure addresses mechanical causes of epiphora (excessive tearing) and recurrent infections related to lacrimal system obstruction.
Service Type: Surgical removal of lacrimal duct or sac foreign body/dacryolith
Typical Site of Service: Ambulatory surgical center or hospital outpatient/inpatient operating room, ophthalmology clinic with surgical capability
Clinical & Coding Specifications
Clinical Context
A 52-year-old patient presents to an ophthalmology clinic with a 3-week history of chronic epiphora (tearing), intermittent medial canthal pain, and mucopurulent discharge despite topical antibiotics. Dacryocystitis is suspected, and lacrimal irrigation demonstrates an obstruction of the nasolacrimal drainage system. After clinical evaluation and nasal endoscopy to rule out distal nasal pathology, the ophthalmic surgeon schedules a procedure to remove a lacrimal sac dacryolith or foreign body under monitored anesthesia care in an ambulatory surgery center. The workflow includes preoperative consent and topical/local anesthesia with possible sedation, localization of the stone within the lacrimal sac or canaliculus, removal with lacrimal probes or forceps, intraoperative irrigation to confirm patency, and placement of temporary stents if indicated. Postoperative instructions cover topical antibiotics and follow-up assessment to confirm resolution of obstruction and healing. Typical site of service is an outpatient ophthalmology clinic procedure room or ambulatory surgery center; hospital outpatient may be used for medically complex patients or when general anesthesia is required.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
00 | Medical direction of two, three, or four concurrent anesthesia procedures | Rare for this ophthalmic procedure; only if anesthesia reporting uses this modifier. |