Summary & Overview
CPT 68770: Closure of Lacrimal Fistula
CPT code 68770 denotes the surgical closure of a lacrimal (tear duct) fistula, a targeted ophthalmic procedure used to stop abnormal tear drainage and address associated inflammation. Nationally, this code is relevant for ophthalmologists, oculoplastic surgeons, ambulatory surgery centers, and payers managing coverage for specialty ocular procedures. Proper coding supports accurate billing, utilization tracking, and payment for a procedure that can improve quality of life by resolving chronic tearing and infection risk.
Payers covered in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. The summary presents what readers will learn about CPT code 68770: clinical context for when the procedure is used, typical sites of service, commonly applied billing modifiers (where noted), and the landscape of payer coverage and reimbursement benchmarks. The publication also highlights policy updates affecting surgical ocular procedures and practical considerations for coding documentation.
Readers will gain a concise reference for CPT code 68770, including its clinical indication, administrative implications for surgical and ambulatory settings, and guidance on where to find additional payer-specific rules. Data not available in the input is identified as such in relevant sections.
Billing Code Overview
CPT code 68770 describes the surgical closure of a fistula in the lacrimal (tear) drainage system. The procedure is performed to correct an abnormal opening in the tear duct that causes persistent tearing or recurrent inflammation.
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Service type: Surgical repair of lacrimal duct fistula
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Typical site of service: Ophthalmology or oculoplastic surgical setting; performed in an outpatient surgical suite or ambulatory surgery center
Clinical & Coding Specifications
Clinical Context
A typical patient is a 45–70-year-old adult presenting with persistent unilateral epiphora (excessive tearing) and recurrent periorbital skin irritation following a traumatic laceration or prior lacrimal surgery. Examination reveals an external cutaneous or conjunctival fistula communicating with the lacrimal drainage system with chronic drainage or inflammation. After diagnostic evaluation — including history, dye disappearance test, lacrimal irrigation and probing, and possible dacryocystography — the oculoplastic surgeon schedules definitive surgical closure of the lacrimal fistula under monitored anesthesia care or general anesthesia.
Preoperative workflow includes informed consent, documentation of the fistula location and etiology, assessment for active infection (treated prior to elective repair), and pre-op marking. Intraoperative steps involve localization of the fistulous tract, excision or curettage of the tract, layered closure of mucosa and skin as needed, and possible placement of a lacrimal stent or silicone intubation if the canalicular system is involved. Postoperative management includes topical antibiotics, anti-inflammatory medications, follow-up to assess healing and lacrimal drainage, and stent removal if used. The typical site of service is an outpatient ambulatory surgery center or hospital outpatient department; the service type is surgical, specifically oculoplastic lacrimal surgery.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
00 | No modifier (default) |