Summary & Overview
CPT 68840: Probing of Lacrimal Canaliculi with or without Irrigation
Headline: CPT code 68840: Probing of the lacrimal canaliculi — brief procedure overview
Lead: CPT code 68840 covers the probing of the lacrimal canaliculi, a brief ophthalmic procedure used to diagnose or relieve obstructions in the tear drainage system. The code is relevant nationally for ophthalmology, otolaryngology, and related outpatient procedural workflows because it denotes a discrete, commonly billed intervention for epiphora (excess tearing) and canalicular obstruction.
CPT code 68840 represents a focused minor surgical procedure to probe and optionally irrigate the lacrimal canaliculi. It matters nationally as a standardized billing descriptor that affects outpatient ophthalmic procedural coding, payer coverage determinations, and encounter-level documentation. Key payers included in the analysis are Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare.
Readers will learn the clinical context for use of the code, typical sites of service, common billing considerations, and where this procedure fits in outpatient ophthalmic care pathways. The summary provides benchmarks and policy-relevant points for payers and providers, and highlights areas where billing clarity, documentation, and coding consistency are commonly applied. Data not available in the input is noted where applicable.
Billing Code Overview
CPT code 68840 describes probing of the lacrimal canaliculi with or without irrigation. This procedure involves insertion of a probe into the small tear drainage channels (canaliculi) to assess or relieve obstruction and may include flushing the system with fluid to confirm patency.
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Service type: Minor surgical/interventional ophthalmic procedure
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Typical site of service: Office or ambulatory surgical center (procedure performed under local anesthesia in an outpatient setting)
Clinical & Coding Specifications
Clinical Context
A typical patient is an adult or pediatric patient presenting to an ophthalmology or oculoplastic clinic with symptoms of epiphora (excessive tearing), recurrent dacryocystitis, or suspected canalicular obstruction after trauma or chronic inflammation. The clinical workflow begins with history and focused ophthalmic exam including eyelid and punctal inspection, dye disappearance test, and irrigation of the lacrimal system. After diagnosis of punctal or canalicular stenosis or suspected obstruction, the clinician schedules a probing of the lacrimal canaliculi with or without irrigation (68840). Procedure is performed in an outpatient ophthalmology suite or ambulatory surgery center under topical anesthesia, local infiltration, or monitored anesthesia care depending on patient age and cooperation. For infants with congenital nasolacrimal duct obstruction, probing may be performed under general anesthesia in a pediatric surgery suite. Post-procedure, topical antibiotics and follow-up are provided to assess patency and symptom resolution. Documentation includes indication, informed consent, anesthesia type, laterality, instruments used, irrigation findings, complications, and post-procedure instructions.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
LT | Left side | When the procedure is performed on the left canaliculus only |
RT | Right side | When the procedure is performed on the right canaliculus only |
50 | Bilateral procedure | When both left and right canaliculi are probed and reported as a single bilateral service where allowed |
59 | Distinct procedural service | When probing is distinct from another service performed at the same visit (e.g., separate incision or unrelated procedure) |
25 | Significant, separately identifiable E/M service | When a significant Evaluation and Management visit is performed the same day as the procedure |
52 | Reduced services | When the service is partially reduced or not completed as planned |
53 | Discontinued procedure | When the procedure is started but halted due to extenuating circumstances |
22 | Increased procedural services | When work or complexity substantially exceeds the usual for 68840 |
26 | Professional component | When reporting only the physician professional component separate from technical component (rare for this procedure) |
57 | Decision for surgery | When the E/M service resulted in the decision to perform the procedure and is reported as a pre-operative service |
56 | Pre-operative management only | When only the preoperative care is provided on the day of surgery |
73 | Discontinued outpatient hospital/ASC procedure prior to anesthesia | When procedure is discontinued before anesthesia is administered |
74 | Discontinued after anesthesia (not in original list) | Data not available in the input. |
| Taxonomy Code | Specialty | Notes |
|---|---|---|
207RE0100X | Ophthalmology | Most common specialty performing lacrimal canaliculi probing |
207RI0012X | Oculoplastic Surgery | Oculoplastic subspecialists often perform complex lacrimal procedures |
363A00000X | Pediatric Ophthalmology | Pediatric specialists perform probing for congenital nasolacrimal duct obstruction |
208000000X | General Practice/Family Medicine | May perform irrigation or initial assessment in some settings |
261G00000X | Otolaryngology | ENT surgeons involved when nasolacrimal duct procedures extend into nasal cavity |
Related Diagnoses
| ICD-10 Code | Description | Clinical Relevance |
|---|---|---|
H04.121 | Dacryocystitis, right lacrimal | Infection/inflammation causing obstruction treated with probing/irrigation |
H04.122 | Dacryocystitis, left lacrimal | Same as above for left side |
H04.129 | Dacryocystitis, unspecified lacrimal | When laterality not specified |
H04.521 | Stenosis of lacrimal canaliculus, right | Direct indication for probing to relieve stenosis |
H04.522 | Stenosis of lacrimal canaliculus, left | Same as above for left side |
H04.529 | Stenosis of lacrimal canaliculus, unspecified | When laterality unspecified |
Q30.0 | Congenital nasolacrimal duct obstruction | Common pediatric indication for canalicular probing |
T15.29 | Foreign body in conjunctival sac, other eye | Foreign bodies may necessitate irrigation/probing to clear debris |
Related CPT Codes
| CPT Code | Description | Relationship to This Procedure |
|---|---|---|
68840 | Probing of lacrimal canaliculi, with or without irrigation | Primary procedure for restoring canalicular patency |
67700 | Repair of lacrimal canaliculus, simple | Used when a canalicular laceration requires direct repair rather than simple probing |
68810 | Dilation of lacrimal punctum; without diagnostic probing | Performed when punctal stenosis requires dilation prior to or instead of probing |
68820 | Probing of lacrimal canaliculus with irrigation for congenital nasolacrimal duct obstruction (performed under general anesthesia) | Common pediatric counterpart when probing for congenital obstruction is performed |
69100 | Diagnostic nasal endoscopy | Performed by ENT or oculoplastics when intranasal evaluation is needed in complex obstructive cases |
69420 | Removal of foreign body from nasal cavity | May be performed if intranasal obstruction or foreign material contributes to lacrimal obstruction |