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CPT 68750: Lacrimal Bypass with Conjunctivonasal Fistula and Tube Placement

CPT code 68750 represents an ophthalmic surgical procedure that creates a fistula between the conjunctiva and the nose and places a stent or tube to maintain patency. It is used to treat disabling tearing due to complete obstruction of the punctum and canaliculi by a fleshy lesion. Nationally, this code captures care provided by ophthalmologists and oculoplastic surgeons addressing functional lacrimal drainage failure and contributes to utilization and spending patterns for surgical lacrimal procedures.

Key payers discussed in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Coverage and coding practices across these payers influence prior authorization requirements, site-of-service considerations, and reimbursement levels for lacrimal bypass procedures.

Readers will find concise clinical context for the procedure, typical sites of service, and an outline of common billing practices. The publication summarizes benchmarks and policy considerations relevant to this procedure, highlights coding nuances for accurate claim submission, and notes areas where data are not available in the input. This content is intended for billing managers, coding professionals, and policy analysts who need a clear national-level overview of CPT code 68750 and its role in ophthalmic surgical services.

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Billing Code Overview

CPT code 68750 describes a surgical procedure in which the provider creates a fistula (tract) between the conjunctiva and the nose and places a tube in the tract to keep it open. This procedure treats excessive tearing (epiphora) caused by a complete blockage of the punctum and canaliculi by a fleshy growth in the corner of the eye.

Service type: Surgical lacrimal bypass with stenting (external conjunctivonasal fistula creation with tube placement)
Typical site of service: Ophthalmology or oculoplastic surgical setting; commonly performed in an operating room or ambulatory surgical center under local or general anesthesia

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CPT 68750: Lacrimal Bypass with Conjunctivonasal Fistula and Tube Placement

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Billing Code Overview

Service type: Surgical lacrimal bypass with stenting (external conjunctivonasal fistula creation with tube placement)
Typical site of service: Ophthalmology or oculoplastic surgical setting; commonly performed in an operating room or ambulatory surgical center under local or general anesthesia

Clinical & Coding Specifications

Clinical Context

A 62-year-old female presents to the ophthalmology clinic with chronic unilateral epiphora (excessive tearing) unresponsive to conservative therapy. Examination demonstrates a fleshy obstruction at the medial canthus with complete obstruction of the punctum and canaliculi confirmed by lacrimal irrigation and dacryoscintigraphy. The ophthalmic surgeon schedules an external conjunctivodacryocystorhinostomy with Jones tube placement to create a permanent fistula between the conjunctival sac and the nasal cavity and inserts a Pyrex glass or silicone tube to maintain patency.

Preoperative workflow includes history and medication review, informed consent, assessment of nasal anatomy by ENT if indicated, and perioperative antibiotics. The procedure is typically performed in an outpatient ambulatory surgery center or hospital minor procedure suite under local anesthesia with sedation or general anesthesia depending on patient factors. Postoperative care includes topical antibiotics and steroids, tube position checks, and saline nasal irrigations. Follow-up visits occur at 1 week, 1 month, and as needed for tube maintenance or replacement.

Coding Specifications

Modifier	Description	When to Use
`25`	Data not available in the input.	Data not available in the input.
`26`	Professional component	Use when only the physician professional component is billed separate from the technical component (rare for this surgical code).
`50`	Bilateral procedure	Use when the procedure is performed on both eyes during the same operative session.
`51`	Multiple procedures	Use when other unrelated procedures are performed in the same session; indicate multiple-procedure payment adjustments.
`52`	Reduced services	Use when the procedure is partially reduced or not completed as originally planned.
`53`	Discontinued procedure	Use when the procedure is started but discontinued due to extenuating circumstances.
`62`	Two surgeons	Use when two surgeons work together as primary surgeons performing distinct portions of the procedure.
`78`	Return to OR for related procedure during postoperative period	Use when the patient returns to the operating room for a related procedure during the global period.
`79`	Data not available in the input.	Data not available in the input.
`RT`	Right side	Use to identify the right eye when laterality reporting is required.
`LT`	Left side	Use to identify the left eye when laterality reporting is required.

Taxonomy Code	Specialty	Notes
`207Y00000X`	Ophthalmology	Primary specialty performing lacrimal bypass with Jones tube placement.
`207L00000X`	Otorhinolaryngology (ENT)	Commonly involved for nasal cavity evaluation and intraoperative assistance for nasal access.
`2080P0207X`	Plastic and Reconstructive Surgery	Performs lacrimal reconstruction when combined with eyelid or facial procedures.
`2084P0800X`	Ophthalmic Plastic and Reconstructive Surgery (Oculoplastic)	Subspecialty that frequently performs lacrimal surgeries including conjunctivodacryocystorhinostomy.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`H04.521`	Epiphora, right lacrimal system	Represents symptomatic excessive tearing due to obstruction on the right; indicates need for lacrimal bypass.
`H04.522`	Epiphora, left lacrimal system	Represents symptomatic excessive tearing due to obstruction on the left; indicates need for lacrimal bypass.
`H04.53`	Epiphora, bilateral	Indicates bilateral symptomatic obstruction that may require bilateral interventions or tube placement.
`H04.7`	Disorders of lacrimal system, unspecified	Useful when a specific lacrimal pathology is not fully specified but surgery is indicated.
`D36.1`	Benign neoplasm of eye, adnexa, orbit	Describes a fleshy growth that may obstruct punctum/canaliculi prompting fistula and tube placement.
`C69.9`	Malignant neoplasm of eye, unspecified	Represents neoplastic obstruction of lacrimal outflow; may necessitate diversion procedures when reconstruction is not feasible.
`K11.89`	Other specified diseases of salivary glands (Data not available in the input.)	Data not available in the input.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`67700`	Repair of canalicular laceration; when performed	May be performed prior to or instead of bypass procedures when canalicular repair is feasible.
`68810`	External dacryocystorhinostomy (DCR), with or without intubation, including when creation of a nasal osteotomy is required	Alternative or adjunct procedure to create a new lacrimal drainage pathway; may be performed in similar clinical scenarios.
`69990`	Unlisted procedure, eyelids, lacrimal system, or orbit (Data not available in the input.)	Used when a procedure related to the lacrimal system is performed that does not have a specific CPT code, though `68750` is the specific code for conjunctivodacryocystorhinostomy with tube.
`66984`	Data not available in the input.	Data not available in the input.
`A4315`	Data not available in the input.	Data not available in the input.

CPT 68700: Repair of Canaliculus Laceration of the Eye

CPT-68705-PUNCTAL-CAUTERY-FOR-EVERTED-PUNCTUM

CPT 68705: Punctal Cautery for Everted Punctum

CPT-68720-DACRYOCYSTORHINOSTOMY-DCR-NASOLACRIMAL-DUCT-REPAIR

CPT 68720: Dacryocystorhinostomy (DCR) for Nasolacrimal Duct Obstruction

CPT-68745-LACRIMAL-FISTULA-CREATION-CONJUNCTIVA-TO-NOSE

CPT 68745: Lacrimal Fistula Creation Between Conjunctiva and Nose

CPT-68760-PUNCTAL-OCCLUSION-FOR-DRY-EYE

CPT 68760: Punctal Occlusion for Dry Eye Syndrome

CPT-68761-PUNCTAL-PLUG-PLACEMENT-FOR-DRY-EYE

CPT 68761: Lacrimal Punctal Plug Placement for Dry Eye Syndrome

CPT-68770-LACRIMAL-FISTULA-CLOSURE

CPT 68770: Closure of Lacrimal Fistula

References

1.CPT® Codes and Descriptions. AAPC. Retrieved Aug 11, 2026.Maintains the CPT code set's official descriptions and guidelines, licensed from the American Medical Association, used as the definitional source for CPT codes on this page.
2.HCPCS Quarterly Update. Centers for Medicare & Medicaid Services (CMS). Retrieved Aug 11, 2026.CMS's quarterly release of HCPCS Level II codes and short/long descriptors, the source for HCPCS code definitions and update history.
3.ICD-10-CM Full Code List. Centers for Medicare & Medicaid Services (CMS). Retrieved Aug 11, 2026.CMS's complete ICD-10-CM diagnosis code list, used to cross-reference diagnosis codes associated with this procedure or service.

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Clinical & Coding Specifications

Clinical Context

Coding Specifications

Modifier	Description	When to Use
`25`	Data not available in the input.	Data not available in the input.
`26`	Professional component	Use when only the physician professional component is billed separate from the technical component (rare for this surgical code).
`50`	Bilateral procedure	Use when the procedure is performed on both eyes during the same operative session.
`51`	Multiple procedures	Use when other unrelated procedures are performed in the same session; indicate multiple-procedure payment adjustments.
`52`	Reduced services	Use when the procedure is partially reduced or not completed as originally planned.
`53`	Discontinued procedure	Use when the procedure is started but discontinued due to extenuating circumstances.
`62`	Two surgeons	Use when two surgeons work together as primary surgeons performing distinct portions of the procedure.
`78`	Return to OR for related procedure during postoperative period	Use when the patient returns to the operating room for a related procedure during the global period.
`79`	Data not available in the input.	Data not available in the input.
`RT`	Right side	Use to identify the right eye when laterality reporting is required.
`LT`	Left side	Use to identify the left eye when laterality reporting is required.

Taxonomy Code	Specialty	Notes
`207Y00000X`	Ophthalmology	Primary specialty performing lacrimal bypass with Jones tube placement.
`207L00000X`	Otorhinolaryngology (ENT)	Commonly involved for nasal cavity evaluation and intraoperative assistance for nasal access.
`2080P0207X`	Plastic and Reconstructive Surgery	Performs lacrimal reconstruction when combined with eyelid or facial procedures.
`2084P0800X`	Ophthalmic Plastic and Reconstructive Surgery (Oculoplastic)	Subspecialty that frequently performs lacrimal surgeries including conjunctivodacryocystorhinostomy.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`H04.521`	Epiphora, right lacrimal system	Represents symptomatic excessive tearing due to obstruction on the right; indicates need for lacrimal bypass.
`H04.522`	Epiphora, left lacrimal system	Represents symptomatic excessive tearing due to obstruction on the left; indicates need for lacrimal bypass.
`H04.53`	Epiphora, bilateral	Indicates bilateral symptomatic obstruction that may require bilateral interventions or tube placement.
`H04.7`	Disorders of lacrimal system, unspecified	Useful when a specific lacrimal pathology is not fully specified but surgery is indicated.
`D36.1`	Benign neoplasm of eye, adnexa, orbit	Describes a fleshy growth that may obstruct punctum/canaliculi prompting fistula and tube placement.
`C69.9`	Malignant neoplasm of eye, unspecified	Represents neoplastic obstruction of lacrimal outflow; may necessitate diversion procedures when reconstruction is not feasible.
`K11.89`	Other specified diseases of salivary glands (Data not available in the input.)	Data not available in the input.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`67700`	Repair of canalicular laceration; when performed	May be performed prior to or instead of bypass procedures when canalicular repair is feasible.
`68810`	External dacryocystorhinostomy (DCR), with or without intubation, including when creation of a nasal osteotomy is required	Alternative or adjunct procedure to create a new lacrimal drainage pathway; may be performed in similar clinical scenarios.
`69990`	Unlisted procedure, eyelids, lacrimal system, or orbit (Data not available in the input.)	Used when a procedure related to the lacrimal system is performed that does not have a specific CPT code, though `68750` is the specific code for conjunctivodacryocystorhinostomy with tube.
`66984`	Data not available in the input.	Data not available in the input.
`A4315`	Data not available in the input.	Data not available in the input.

CPT 68700: Repair of Canaliculus Laceration of the Eye

CPT-68705-PUNCTAL-CAUTERY-FOR-EVERTED-PUNCTUM

CPT 68705: Punctal Cautery for Everted Punctum

CPT-68720-DACRYOCYSTORHINOSTOMY-DCR-NASOLACRIMAL-DUCT-REPAIR

CPT 68720: Dacryocystorhinostomy (DCR) for Nasolacrimal Duct Obstruction

CPT-68745-LACRIMAL-FISTULA-CREATION-CONJUNCTIVA-TO-NOSE

CPT 68745: Lacrimal Fistula Creation Between Conjunctiva and Nose

CPT-68760-PUNCTAL-OCCLUSION-FOR-DRY-EYE

CPT 68760: Punctal Occlusion for Dry Eye Syndrome

CPT-68761-PUNCTAL-PLUG-PLACEMENT-FOR-DRY-EYE

CPT 68761: Lacrimal Punctal Plug Placement for Dry Eye Syndrome

CPT-68770-LACRIMAL-FISTULA-CLOSURE

CPT 68770: Closure of Lacrimal Fistula

References

1.CPT® Codes and Descriptions. AAPC. Retrieved Aug 11, 2026.Maintains the CPT code set's official descriptions and guidelines, licensed from the American Medical Association, used as the definitional source for CPT codes on this page.
2.HCPCS Quarterly Update. Centers for Medicare & Medicaid Services (CMS). Retrieved Aug 11, 2026.CMS's quarterly release of HCPCS Level II codes and short/long descriptors, the source for HCPCS code definitions and update history.
3.ICD-10-CM Full Code List. Centers for Medicare & Medicaid Services (CMS). Retrieved Aug 11, 2026.CMS's complete ICD-10-CM diagnosis code list, used to cross-reference diagnosis codes associated with this procedure or service.

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CPT 68750: Lacrimal Bypass with Conjunctivonasal Fistula and Tube Placement

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Billing Code Overview

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CPT 68750: Lacrimal Bypass with Conjunctivonasal Fistula and Tube Placement

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Billing Code Overview

Clinical & Coding Specifications

Clinical Context

Coding Specifications

Related Diagnoses

Related CPT Codes

Related Codes

References

Clinical & Coding Specifications

Clinical Context

Coding Specifications

Related Diagnoses

Related CPT Codes

Related Codes

References