2025 CPT code 68115
(Active) Effective Date: N/A Revision Date: N/A Deletion Date: N/A Surgery - Surgical Procedures on the Eye and Ocular Adnexa Surgery Feed
Excision of a conjunctival lesion larger than 1 cm.
Modifiers may be applicable depending on the circumstances of the procedure. Consult the CPT manual for appropriate modifier usage, such as 51 (Multiple Procedures) if multiple lesions are excised, or 22 (Increased Procedural Services) if the procedure was unusually complex.Refer to the modifier crosswalk provided in the source documentation for details on permissible modifiers.
Medical necessity for this procedure would be established based on the patient's symptoms, the size and location of the lesion, and the potential impact on vision and comfort.A large, symptomatic conjunctival lesion may require excision to alleviate symptoms and prevent potential complications such as infection or vision impairment.
The ophthalmologist or surgeon is responsible for performing the excision, ensuring proper preparation and anesthesia of the patient, and for meticulous surgical technique to minimize complications.
In simple words: The doctor removes a growth on the inside of the eyelid that is larger than 1 centimeter to reduce pain, pressure, and possibly improve vision. This involves numbing the area, carefully cutting out the growth, and stitching the area closed if necessary.
This procedure involves the surgical removal of a lesion on the conjunctiva (the mucous membrane lining the inner surface of the eyelid) that measures greater than 1 centimeter in diameter.The procedure aims to alleviate pain, pressure, and potentially improve vision.It typically includes prepping and anesthetizing the patient, using a lid speculum for examination, placing a traction suture, employing a corneal light shield to prevent phototoxicity, marking the lesion with a margin of 3-4mm, excising the lesion, and suturing the incision if needed.
Example 1: A 65-year-old patient presents with a large, painful pinguecula (a yellowish growth) on the conjunctiva of their right eye, measuring 1.5 cm. The ophthalmologist performs an excision of the lesion under local anesthesia., A 40-year-old patient has a 2cm conjunctival nevus (a pigmented lesion) that is enlarging and causing irritation. The ophthalmologist excises the lesion, taking a 3-4 mm margin, and sends the tissue for pathological examination., A 72-year-old patient with a history of chronic inflammation has a large (2.2 cm) area of granulation tissue on the conjunctiva.The ophthalmologist performs an excision, achieving complete removal of the lesion, with no need for sutures.
* Thorough preoperative assessment, including detailed description of the lesion's size, location, and any associated symptoms.* Operative report detailing the surgical technique used, size of the excised lesion, and histopathological findings (if applicable).* Postoperative assessment, including any complications.* Photographic documentation of the lesion before and after excision is recommended for completeness.
** Careful documentation is critical to ensure proper code selection. The distinction between excision and biopsy is paramount.The size of the lesion is the key differentiating factor between codes 68110 and 68115.Always refer to the current CPT manual and payer guidelines for the most up-to-date information.
- Revenue Code: P6C (Medicare Fee Schedule: MINOR PROCEDURES - OTHER)
- RVU: This information is not available in the provided source.Consult the current CPT codebook or your payer's fee schedule for RVU values and reimbursement rates.
- Global Days: This information is not provided in the source. The global period would need to be determined based on the specific payer's guidelines and the surgical complexity.
- Payment Status: Active
- Modifier TC rule: Information on the applicability of a Technical Component (TC) modifier is not provided. Consult payer guidelines for clarification on whether a TC modifier is appropriate based on the specific setting of service.
- Fee Schedule: This information is not available in the provided sources.Consult historical CPT code books or payer-specific fee schedules for historical fee data.
- Specialties:Ophthalmology
- Place of Service:Office, Ambulatory Surgical Center, Hospital Outpatient