Ophthalmology and Optometry Coding Alert

Question: What CPT code would be best to use for repairing a lacrimal gland prolapse? Basically, the physician performed an orbitotomy. The prolapsed gland was suspended from the inner aspect of the periosteum of the frontal bone with double arm 5-0 vicryl. Would 68899 for "unlisted lacrimal system procedure" or 67400 for "orbitotomy without bone flap" be more appropriate?

Utah Subscriber

Answer: Report both the orbitotomy (67400, Orbitotomy without bone flap [frontal or transconjunctival approach]; for exploration, with or without biopsy) and a lacrimal gland prolapse repair with 68899 (Unlisted procedure, lacrimal system). You should report the unlisted procedure code only if the retinal specialistdid not perform a CPT defined procedure.

Code 67400 is for orbit exploration. If the documentation supports an orbitotomy, report 67400.

Before you use 68899, check with the retina specialist or look in his notes. Did he take a biopsy of the lacrimal gland (68510, Biopsy of lacrimal gland) or excise any fat from the gland (68505, Excision of lacrimal gland [dacryoadenectomy], except for tumor; partial)? If so, the codes for these procedures may be more appropriate than the unlisted procedure code.

If the specialist sutured the gland back into place without performing a CPT defined lacrimal gland procedure, use 68899 for the lacrimal gland prolapse repair. CPT contains no code for suturing the gland back into place.