Summary & Overview
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.
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.
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Service type: Surgical lacrimal bypass with stenting (external conjunctivonasal fistula creation with tube placement)
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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 |