2025 CPT code 68100
(Active) Effective Date: N/A Surgery - Surgical Procedures on the Eye and Ocular Adnexa Feed
Biopsy of conjunctiva.
Modifiers may be applicable. Modifier 50 is used for bilateral procedures, while -RT and -LT may be required by some payers. Other modifiers, such as 22 (increased procedural services) or 52 (reduced services), might apply in specific situations.
Medical necessity for a conjunctival biopsy must be supported by documentation of signs, symptoms, or abnormal findings suggestive of a condition requiring a tissue diagnosis.
The physician prepares the patient, administers anesthesia, obtains the tissue sample, and may repair the biopsy site with sutures. The sample is then sent to pathology for analysis.
In simple words: A small tissue sample is taken from the lining of your eye or eyelid for examination under a microscope.This helps the doctor figure out what's going on.
This code represents a biopsy procedure performed on the conjunctiva of the eye for diagnostic purposes. The procedure may involve removing a tissue sample using a curette and possibly suturing the wound.
Example 1: A patient presents with a suspicious lesion on their conjunctiva. A biopsy is performed to determine if it is cancerous., A patient with persistent conjunctivitis undergoes a biopsy to identify the underlying cause of the inflammation., A biopsy is taken from a patient's conjunctiva to diagnose a suspected infection.
Documentation should include the location and description of the lesion, the method of biopsy, and any complications encountered. The pathology report should also be included in the patient's medical record.
** The difference between a biopsy and an excision should be carefully documented.If a complete excision of the lesion is performed, codes 68110-68130 should be considered instead.
- Payment Status: Active
- Specialties:Ophthalmology
- Place of Service:Ambulatory Surgical Center, Hospital Outpatient Department, Physician's Office