Ophthalmology and Optometry Coding Alert

Question: When billing for closure of punctum by plug, is it appropriate to bill for dilation of lacrimal punctum as well?

Kim Walker
Rochester Ophthalmology Group
Rochester, NY

Answer: No, you cant bill for punctal plugs (68761) in addition to dilation of lacrimal punctum (68801*) or any of the probing codes (68810*, 68811, 68815, 68840*). Yes, you do have to dilate the punctum to insert the plug, but that is why you cant bill for the dilation. Under CPT convention, when you have to perform procedure A to do procedure B, procedure A is automatically considered an integral part of procedure B. In this case, dilation is an integral part of insertion of the plug.

Note that 68801* is for dilation of the punctum with or without irrigation, 68810* is for probing of the nasolacrimal duct with or without irrigation (68811 requiring general anesthesia, and 68815 with insertion of a tube or stent), and 68840* is for probing of the lacrimal canaliculi, with or without irrigation. These procedures are all done to make sure that the passageway is open; plugs are inserted to close the passageway. Irrigation is to see if the fluid will flow down the nasal lacrimal tube. Dilation is just enlarging the punctum itself. And the probe is usually a thin wire that is pushed into the canal. The diagnosis code for punctal plugs would be quite different from the diagnosis code for dilation or probing.