Summary & Overview
CPT 68550: Lacrimal Gland Excision via Orbital/Bony Approach
CPT code 68550 designates surgical excision of the lacrimal gland via an approach that involves cutting into surrounding bony orbital structures, performed to remove a potentially malignant tumor with the specimen sent for pathologic analysis. This code captures a complex oculoplastic procedure with implications for surgical planning, perioperative care, and pathology services, and is relevant for facility and physician billing in operative ophthalmology.
Key national payers addressed include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise review of the clinical context for lacrimal gland tumor excision, typical sites of service (hospital operating room or ambulatory surgery center), and common billing considerations tied to operative classification. The publication provides benchmarks and payment context where available, outlines billing nuances associated with an orbitotomy approach, and summarizes coding considerations that affect claim adjudication and facility-versus-professional responsibilities. It also highlights areas where policy updates or payment variability commonly occur for complex orbital procedures.
Intended for clinicians, coding professionals, and policy analysts, the report provides actionable clarity on the scope and clinical intent of 68550, plus the billing and administrative topics stakeholders commonly review when managing claims for lacrimal gland tumor excision.
Billing Code Overview
CPT code 68550 describes surgical removal of the lacrimal gland using an approach that involves cutting into the bony orbital structures. The procedure is performed to excise a potentially malignant tumor and includes submission of the specimen to the laboratory for diagnostic analysis.
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Service type: Surgical excision of lacrimal gland with bone-involving approach for tumor removal
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Typical site of service: Hospital operating room or ambulatory surgery center, performed by an oculoplastic or ophthalmic surgeon
Clinical & Coding Specifications
Clinical Context
A typical patient is a 62-year-old adult referred to an oculoplastic surgeon for a firm, enlarging mass in the lacrimal gland region causing eyelid fullness, discomfort, and possible proptosis. Imaging (CT or MRI) demonstrates a lesion within the lacrimal fossa with concern for malignancy. The surgeon schedules an operative procedure under general anesthesia with an orbitotomy that includes removal of the lacrimal gland through bone work (e.g., lateral orbitotomy with bone removal) to obtain complete excision. Intraoperatively the surgeon performs an en bloc gland excision, secures hemostasis, and sends the specimen for pathological analysis. Postoperative workflow includes immediate recovery, pathology review for tumor type and margins, and outpatient follow-up for wound checks, ocular motility assessment, and adjuvant oncology referral if malignancy is confirmed. Typical site of service is an ambulatory surgery center or hospital operating room. Service type is a surgical excision via orbitotomy with specimen sent for diagnostic pathology, coded by 68550.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
22 | Increased procedural services | Use when the work, time, or intensity substantially exceeds typical for 68550. Documentation must support reason. |