Summary & Overview
CPT 68720: Dacryocystorhinostomy (DCR) for Nasolacrimal Duct Obstruction
CPT code 68720 represents a dacryocystorhinostomy (DCR), a surgical procedure to restore tear drainage by creating a new passage between the lacrimal sac and the nasal cavity. DCR is a definitive treatment for nasolacrimal duct obstruction, commonly performed by ophthalmic plastic surgeons and otolaryngologists. Nationally, this code denotes an operative intervention with implications for surgical settings, anesthesia use, and post-operative care pathways.
Key payers included in this overview 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 (hospital operating room and ambulatory surgery center), and the types of benchmarks and policy items typically associated with a surgical ophthalmologic code such as reimbursement benchmarks, authorization and coverage considerations, and coding compliance issues. The summary highlights where CPT code 68720 fits within care delivery for lacrimal system disorders and what clinical and administrative stakeholders should expect when this procedure is billed.
This publication provides practical reference material: code definition and clinical purpose, payer coverage scope, and the kinds of metrics and policy updates that commonly affect utilization and payment for surgical lacrimal procedures. Data not available in the input is noted where applicable.
Billing Code Overview
CPT code 68720 describes a dacryocystorhinostomy (DCR), a surgical procedure performed to correct dysfunction of the nasolacrimal duct and restore drainage of tears from the tear duct into the nose. The procedure creates a direct opening between the lacrimal sac and the nasal cavity to bypass an obstructed nasolacrimal duct.
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Service type: Surgical procedure, ophthalmologic/otolaryngologic lacrimal surgery
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Typical site of service: Hospital operating room or ambulatory surgery center
Clinical & Coding Specifications
Clinical Context
A 62-year-old female presents with chronic epiphora (excessive tearing), recurrent dacryocystitis, and confirmed nasolacrimal duct obstruction on dacryocystography. Conservative treatments including topical antibiotics and lacrimal irrigation have failed. The ophthalmic oculoplastic surgeon schedules a dacryocystorhinostomy to create a direct anastomosis between the lacrimal sac and the nasal cavity to restore tear drainage. Preoperative evaluation includes nasal endoscopy, medical history review, anticoagulation management, and informed consent. The procedure is typically performed in an ambulatory surgical center or hospital operating room under monitored anesthesia care or general anesthesia. Intraoperative steps include exposure of the lacrimal sac, creation of a bony ostium, marsupialization of the sac to the nasal mucosa, and placement of silicone stents as indicated. Postoperative workflow includes recovery monitoring, topical antibiotic/steroid drops, follow-up visits for stent removal (if placed), and wound/infection surveillance.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
22 | Increased procedural services | Use when work required is substantially greater than typical for 68720 (document increased effort). |