Summary & Overview
CPT 68700: Repair of Canaliculus Laceration of the Eye
CPT code 68700 represents surgical repair of a laceration of the canaliculus of the eye, an ophthalmic procedure performed to restore lacrimal drainage anatomy, prevent infection, and relieve pain. Nationally, this code is used for acute traumatic injuries to the canalicular system and is relevant for surgical specialty billing, trauma care pathways, and ophthalmology practice management. Key payers discussed include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise clinical context for the procedure, typical sites of service, common modifiers used with this code, and payer coverage considerations. The publication provides benchmarks and coding guidance context, highlights billing nuances for outpatient versus inpatient settings, and summarizes payer-specific coverage patterns where available. Data not provided in the input are noted explicitly. This overview is intended for coding professionals, revenue cycle managers, and clinicians seeking a clear, national-level summary of CPT code 68700 and its application in practice.
Billing Code Overview
CPT code 68700 describes surgical repair of a laceration of the canaliculus of the eye. The procedure addresses injury to the lacrimal drainage canaliculus to restore anatomy, prevent infection, and relieve pain or discomfort.
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Service type: Surgical repair of the canalicular laceration (ophthalmic lacrimal surgery)
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Typical site of service: Operating room or procedure suite in an outpatient surgical center or hospital setting when specialized ophthalmic reconstruction is required.
Clinical & Coding Specifications
Clinical Context
A 28-year-old male is brought to the ophthalmology clinic after sustaining a facial laceration near the medial canthus from a bicycle accident. On examination there is a full-thickness tear involving the lower canaliculus with associated epiphora and pericanalicular swelling. The surgeon performs a primary canaliculus repair (68700) under local anesthesia in a procedure room to restore canalicular continuity, place a stent (silastic intubation), and reduce risk of infection and later epiphora. The workflow includes preoperative consent, tetanus and antibiotic prophylaxis assessment, administration of local anesthetic with monitored sedation as needed, surgical exploration of the canalicular injury, identification of the proximal and distal canalicular ends, microsurgical repair with fine sutures and stent placement, irrigation to confirm patency, dressing application, and postoperative instructions for eye care and follow-up for stent removal and functional assessment.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
11 | Baseline (usual) service | When procedure performed as the provider's standard service without unusual circumstances |
22 |