2025 CPT code 68130
(Active) Effective Date: N/A Surgery - Surgical Procedures on the Eye and Ocular Adnexa Feed
Excision of lesion, conjunctiva; with adjacent sclera.
Modifiers are allowed. Common modifiers include 50 (bilateral procedure), 22 (increased procedural service), and laterality modifiers (RT/LT).
Medical necessity must be established by documenting the symptoms caused by the lesion (e.g., pain, impaired vision, foreign body sensation) and its effect on the patient's quality of life. Pre-operative photographs are beneficial in demonstrating the medical necessity of the procedure.
The ophthalmologist is responsible for the entire procedure, from prepping and anesthetizing the patient to excising the lesion and suturing the incision.
In simple words: The doctor removes a growth from the white part of your eye and the covering of the inside of your eyelid.This is done to relieve pain or pressure, and sometimes to help you see better.
This code describes a surgical procedure where a lesion on the conjunctiva and the adjacent scleral tissue are excised. This procedure is often performed to alleviate pain, pressure, and potentially to improve vision. The procedure involves prepping and anesthetizing the patient, placing a lid speculum, and examining the eye. A traction suture is placed, and a corneal light shield is used. The lesion and a margin of 3-4mm are marked and excised. If necessary, the incision is sutured.
Example 1: A patient presents with a pterygium encroaching on the cornea. The ophthalmologist performs an excision of the pterygium and adjacent sclera using code 68130., A patient has a squamous cell carcinoma on the conjunctiva near the limbus. The lesion involves both the conjunctiva and a small area of adjacent sclera. Code 68130 is used to describe the excision., A patient has a conjunctival cyst that is firmly attached to the underlying sclera. The ophthalmologist excises the cyst along with the adjacent sclera to ensure complete removal. Code 68130 is reported.
Documentation should include the size and location of the lesion, the involvement of adjacent sclera, the method of excision, and any complications. If a biopsy was performed, this should be clearly distinguished from the excision. Operative reports should detail the pre-operative examination, anesthesia used, surgical technique, and post-operative instructions.
** If excessive conjunctiva is removed, a mucous membrane graft or amniotic membrane graft might be necessary for reconstruction. These would be coded separately.
- Revenue Code: P4E - EYE PROCEDURE - OTHER
- Payment Status: Active
- Specialties:Ophthalmology
- Place of Service:Ambulatory Surgical Center, Hospital Outpatient, Office