Summary & Overview
CPT 78660: Diagnostic Nuclear Imaging of Lacrimal (Tear) System
CPT code 78660 represents dacryoscintigraphy, a diagnostic nuclear medicine study of the lacrimal (tear) drainage system in which a radioactive tracer is instilled in the eye and imaged with a gamma camera to locate obstruction. This procedure matters nationally because it informs the diagnosis and management of epiphora and other lacrimal drainage disorders, guiding ophthalmology and oculoplastic care and impacting downstream surgical and medical management.
Key payers discussed include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. The publication provides a concise reference on clinical context, typical sites of service, common billing modifiers, and payer coverage considerations where available. Readers will find benchmarks and policy-relevant information when present, practical coding and billing context, and a summary of what is known about procedural use and clinical indications. Data not available in the input is explicitly flagged where applicable.
This summary is written for a national audience of clinicians, coding specialists, and policy analysts seeking a compact, authoritative overview of CPT code 78660 and its clinical role in lacrimal imaging.
Billing Code Overview
CPT code 78660 describes a diagnostic nuclear imaging study of the lacrimal (tear) drainage system. In this procedure, a provider introduces a radioactive tracer into the eye and acquires sequential images using a gamma camera to identify the site and extent of obstruction within the lacrimal drainage apparatus.
Service type: Diagnostic nuclear medicine imaging
Typical site of service: Outpatient imaging center or hospital radiology/nuclear medicine department
Clinical & Coding Specifications
Clinical Context
A 58-year-old female presents to an ophthalmology clinic with a 6-month history of unilateral epiphora (excessive tearing) and intermittent mucopurulent discharge. Conservative measures including topical antibiotics and lacrimal massage provided minimal relief. The ophthalmologist suspects an obstruction in the lacrimal drainage system (nasolacrimal duct or canalicular obstruction) and schedules a diagnostic lacrimal scintigraphy study to localize the site and degree of obstruction prior to planning dacryocystorhinostomy or probing.
Workflow:
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Patient arrives at the nuclear medicine or ophthalmic imaging suite with a recent clinical assessment documenting epiphora and prior conservative treatment.
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A topical anesthetic and antiseptic are applied; a microdrop of radiotracer (typically technetium-99m sulfur colloid or pertechnetate in an appropriate ophthalmic vehicle) is instilled into the conjunctival sac of the affected eye(s).
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Dynamic and static imaging is performed with a gamma camera at timed intervals to visualize tracer transit from the puncta through canaliculi into the lacrimal sac and nasolacrimal duct, and into the nasal cavity.
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Images are reviewed by the interpreting physician (nuclear medicine physician or ophthalmologist with nuclear medicine training) to determine whether there is normal drainage, partial delay, or complete obstruction and to localize the level (punctal, canalicular, sac, or ductal).
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A written report documents the procedure, tracer used, imaging times, findings, and impression to guide subsequent therapeutic planning (e.g., probing, intubation, dacryocystorhinostomy). Typical sites of service are outpatient hospital-based imaging centers, ambulatory surgical centers, or specialty imaging clinics.