2025 CPT code 68899
Effective Date: N/A Surgery - Surgical Procedures on the Eye and Ocular Adnexa Feed
Unlisted procedure, lacrimal system.
Modifiers may be applicable. Appropriate modifiers should be appended based on the specific circumstances of the procedure.
Medical necessity must be clearly documented. Because this code is for unlisted procedures, the documentation must explain why existing codes are inadequate and why this novel approach was necessary.
The physician performs a procedure on the lacrimal system not otherwise described in the CPT code set. This requires detailed documentation and justification.
In simple words: This code represents a procedure performed on the tear ducts that doesn't have its own specific code.
This code is used for new or unusual procedures performed on the lacrimal system that do not have a dedicated CPT code.
Example 1: A patient presents with a complex lacrimal duct obstruction not amenable to standard dacryocystorhinostomy (DCR) techniques. The surgeon performs a novel endoscopic procedure to bypass the obstruction. As this is a unique approach, 68899 is reported., Repair of a severely damaged lacrimal gland due to trauma, requiring a complex reconstruction not covered by other codes, would necessitate the use of 68899., A patient has a rare congenital anomaly of the lacrimal drainage system. The surgeon performs a corrective procedure not described by existing CPT codes. This would be reported with 68899.
Operative report detailing the procedure performed, the medical necessity for employing an unlisted code, and any comparable existing codes. Supporting documentation such as pre- and post-operative images may also be beneficial.
** Always verify payer-specific guidelines before billing this code. Proper documentation and communication with payers is crucial for successful reimbursement.
- Specialties:Ophthalmology, Oculoplastic Surgery
- Place of Service:Ambulatory Surgical Center, Hospital Outpatient Department, Office