👁️ CPT 68820 — Probing of Nasolacrimal Duct, With or Without Irrigation; After Unsuccessful Probing
Quick Reference
wRVU: 1.46 | Global Period: 010 | Assistant Payable: No | Bilateral Indicator: 1 Bilateral Indicator 1 means the 150% bilateral rule applies: if performed bilaterally, the total payment is 150% of the single-eye rate, achieved by appending modifier -50 or reporting -RT/-LT on separate lines. The 010-day global period means all post-operative care within 10 days of the procedure is bundled into the surgical payment, and a separate E/M cannot be billed unless a new, unrelated problem is addressed with modifier -24. Assistant surgeon is not separately payable for this procedure, as it is a relatively straightforward re-probing that does not require a surgical assistant. PC/TC indicator 0 means this is a surgical procedure with no professional/technical component split.
📋 Clinical Description
CPT 68820 describes a second or subsequent probing of the nasolacrimal duct, performed with or without irrigation, specifically in cases where a prior probing attempt (reported with 68810 or 68811) has failed to resolve the obstruction or restore lacrimal drainage patency. This code is integral to the stepwise management of nasolacrimal duct obstruction (NLDO), most commonly encountered in the pediatric population where congenital membranous obstruction at the valve of Hasner fails to resolve spontaneously or after initial probing, though it may also be used in adults with acquired stenosis or stricture.
The distinction from 68810 (initial probing, with or without irrigation) is critical — 68820 is specifically reserved for repeat attempts after a documented prior unsuccessful probing, making proper sequencing in the medical record and claim submission essential. When probing is performed under general anesthesia as a primary or repeat procedure, 68811 applies to the initial attempt; 68820 is the appropriate code regardless of anesthesia type for the repeat attempt, and documentation must clearly reflect the prior failure. If at the time of repeat probing the surgeon also places a tube or stent (e.g., a Crawford silicone intubation set), 68815 or 68816 should be considered instead of 68820, as the insertion of a device changes the procedure character entirely.
This procedure may be performed in the following clinical contexts:
- Congenital NLDO with failed initial probing — The most common scenario, typically in infants aged 6-18 months who did not respond to initial office-based probing or conservative management with massage and topical antibiotics; 68820 covers the repeat procedural attempt. The documentation must reflect the prior probing date and its failure to achieve patency.
- Recurrent epiphora following initial probing — A patient who initially had apparent success with 68810 but returns with recurrent tearing weeks to months later, and the physician performs a second probing to re-establish drainage; the recurrence must be documented clinically before 68820 is reported.
- Bilateral NLDO with asymmetric response — A child with bilateral obstruction in whom one duct responded to initial probing but the contralateral duct did not; only the non-responding eye should be coded with 68820, with the prior attempt on that specific side documented in the record.
- Adult acquired stenosis requiring repeat instrumentation — Adults with stenosis related to chronic dacryocystitis, systemic inflammatory conditions, or post-traumatic narrowing occasionally require repeat probing attempts before advancing to dacryocystorhinostomy (68720); documentation of prior attempt is required.
- Post-operative stricture following lacrimal surgery — Rarely, re-probing may be required following prior lacrimal surgery where scarring has re-obstructed the duct; in this scenario, modifier -58 (staged or related procedure) may apply if within the global period of a prior lacrimal procedure.
🔬 Anatomical & Procedural Considerations
| Variant | Mechanism | Key Notes |
|---|---|---|
| Repeat probing with irrigation | The surgeon inserts a dilator into the lacrimal punctum, then advances a Bowman probe through the canaliculus, lacrimal sac, and nasolacrimal duct under direct visualization or tactile guidance, followed by irrigation with saline or antibiotic solution to confirm patency and flush any residual mucus or debris. | Irrigation confirmation — the appearance of fluid at the nasal meatus or the patient swallowing the irrigant — is the gold-standard endpoint; failure to achieve this confirms persistent obstruction and should be documented to support medical necessity for any subsequent procedure. Irrigation is included in the code and not separately billable. |
| Repeat probing without irrigation | The surgeon performs re-probing using tactile landmarks and resistance feedback to navigate the duct, without formal irrigation; this variant may be chosen based on patient tolerance, surgeon preference, or setting limitations. | Even without irrigation, the code descriptor covers the service fully; it is not appropriate to append a separate code or modifier to indicate the absence of irrigation, as the code is priced to encompass both variations. Documentation should note why irrigation was not performed if this is the surgeon’s standard practice, to support audit defense. |
| Repeat probing under general anesthesia | In pediatric patients or uncooperative adults, the re-probing is performed in an ASC or OR setting under general anesthesia; unlike the initial probing scenario where 68811 is the anesthesia-specific code, there is no separate “general anesthesia” variant code for the repeat attempt — 68820 applies regardless of anesthesia type. | Anesthesia for 68820 is reported separately by the anesthesia provider using the appropriate anesthesia CPT code; the operating surgeon does not report the anesthesia. When billing in an ASC setting (POS 24), facility charges are submitted separately from the professional (physician) claim. |
Clinical Pearl
The most important coding distinction in this code family is the difference between 68820 (repeat probing, any setting, failed prior attempt) and 68811 (initial probing under general anesthesia). Do NOT report 68811 for a second probing simply because it is done under general anesthesia — the surgical history drives the code selection here, not the anesthesia type. Auditors and payers will cross-reference prior claims data; if a 68810 or 68811 is on file for the same eye within a recent period, a subsequent claim for 68820 should match clinically. Always document the date and outcome of the prior probing in the operative report or procedure note for 68820.
✅ Procedure Includes
- Dilation of the lacrimal punctum as a necessary step to introduce the probe — this is not separately reported with 68801 when performed as part of 68820, as it is considered inherent to the approach.
- Probing of the canaliculus and passage of the Bowman probe (or equivalent) through the nasolacrimal duct to the nasal cavity, including any manipulation required to pass through areas of stenosis or membranous obstruction.
- Irrigation of the lacrimal drainage system with saline or antibiotic solution when performed — this is bundled into the code and not separately billable.
- Tactile and visual assessment of duct patency during the procedure, including documentation of the endpoint (e.g., fluid at naris, nasal meatus visualization).
- Local anesthesia when administered by the operating surgeon — topical or infiltrative local anesthesia used during an office-based or ASC procedure is included in the surgical fee and is not separately reportable.
- Routine post-operative care within the 10-day global period, including any follow-up visits directly related to the probing procedure.
❌ Excludes / Do Not Report Together
| Code | Description | Relationship |
|---|---|---|
| 68810 | Probing of nasolacrimal duct, with or without irrigation (initial) | These codes are mutually exclusive for the same eye on the same date. 68810 is the initial probing; 68820 applies only when a prior probing has already been performed and documented. Reporting both on the same claim for the same eye will result in a denial based on CCI edits. |
| 68811 | Probing of nasolacrimal duct, with or without irrigation; requiring general anesthesia | 68811 is the initial probing under general anesthesia code; it does NOT apply to repeat probing. For a second or subsequent probing performed under general anesthesia, 68820 is the correct code — not 68811. Reporting 68811 for a repeat probing when a prior probing is already on file is a misrepresentation of the service. |
| 68815 | Probing of nasolacrimal duct, with or without irrigation; with insertion of tube or stent | If a tube or stent is placed during the re-probing, 68815 is the appropriate code — not 68820. The insertion of hardware fundamentally changes the procedure, and 68815 carries a higher RVU; reporting 68820 when a stent is placed would result in undercoding. |
| 68801 | Dilation of lacrimal punctum, with or without irrigation | Punctal dilation is inherent to the approach for nasolacrimal probing and is bundled under CCI edits; it cannot be reported separately on the same date as 68820 for the same eye, even if performed as a distinct step. |
Bundling Alert
CPT 68820 has a 010-day global period, meaning any E/M service or procedure directly related to the probing is bundled for the 10 days following the procedure date. An E/M billed during the global period for a related complaint (e.g., persistent tearing, eye discharge) will be denied unless modifier -24 is appended with documentation clearly establishing that the visit was for a new, unrelated condition. Additionally, bilateral billing must be handled precisely: if both eyes are probed on the same date, report 68820-50 (or 68820-RT and 68820-LT on separate lines) — failure to append the bilateral modifier and submitting two separate lines of 68820 without laterality distinction is a common audit finding. Because 68820 does not have a “general anesthesia” variant code the way the initial probing family does, ensure the operative report specifies it is a repeat probing to withstand payer scrutiny.
🌳 Code Tree — Surgery: Eye and Ocular Adnexa / Lacrimal System
CPT 65091-68899 Surgery: Eye and Ocular Adnexa
│
├── 68400-68850 Procedures on the Lacrimal System
│
│ ├── 68800-68850 Probing and/or Related Procedures on the Lacrimal System
│ │
│ │ ├── 68801 Dilation of lacrimal punctum, with or without irrigation (Global: 000)
│ │ ├── 68810 Probing of nasolacrimal duct, with or without irrigation (Global: 010)
│ │ ├── 68811 Probing of nasolacrimal duct, with or without irrigation; requiring general anesthesia (Global: 010)
│ │ ├── ▶▶ 68820 ◀◀ Probing of nasolacrimal duct, with or without irrigation; after unsuccessful probing ← YOU ARE HERE (Global: 010)
│ │ ├── 68815 Probing of nasolacrimal duct, with or without irrigation; with insertion of tube or stent (Global: 090)
│ │ ├── 68816 Probing of nasolacrimal duct, with or without irrigation; with transluminal balloon catheter dilation (Global: 090)
│ │ └── 68840 Probing of lacrimal canaliculi, with or without irrigation (Global: 000)
│
└── 68700-68770 Repair Procedures on the Lacrimal System
├── 68720 Dacryocystorhinostomy (DCR) (Global: 090)
└── 68745 Conjunctivorhinostomy (Global: 090)
💰 RVU & Reimbursement Profile
| Component | Value |
|---|---|
| Work RVU | 1.46 |
| Global Period | 010 |
| Bilateral Indicator | 1 (150% rule applies) |
| Assistant Surgeon | Not payable |
| Co‑Surgeon | Not payable |
| Team Surgery | Not payable |
| PC/TC Split | N/A — surgical procedure (indicator 0) |
| Modifier -51 Exempt | No |
| Anesthesia | Reported separately by anesthesia provider |
Bilateral Billing Rules
With Bilateral Indicator 1, the standard bilateral payment rule applies: if 68820 is performed on both eyes on the same date of service, Medicare reimburses at 150% of the single-eye allowable. The surgeon should report 68820-50 on a single claim line, or 68820-RT and 68820-LT on two separate lines, depending on payer preference — verify MAC or commercial payer requirements before submitting. The 2.5% CMS efficiency adjustment effective January 1, 2026 has already been applied to the wRVU of 1.46, so the pre-2026 wRVU was slightly higher at approximately 1.50. Estimated Medicare non-facility payment (**at the 2026 non-QP conversion factor of 48.76 before GPCI locality adjustment; bilateral reimbursement would be approximately $73.14.
🏷️ Modifier Reference
| Modifier | Name | When to Apply |
|---|---|---|
| -RT | Right Side | Append when 68820 is performed only on the right nasolacrimal duct; use in place of -50 when only one side is treated, or in combination with -LT on a separate line for bilateral reporting per payer preference. |
| -LT | Left Side | Append when 68820 is performed only on the left nasolacrimal duct; required for laterality specificity and to match the ICD-10-CM diagnosis code laterality (e.g., H04.532 for left neonatal obstruction). |
| -50 | Bilateral | Use when 68820 is performed on both nasolacrimal ducts on the same operative session; report on a single line with one unit — do not report two units of the same code without bilateral modifier, as this will appear as duplicate billing. |
| -25 | Significant, Separately Identifiable E/M | Append to the E/M code (not to 68820) when a decision to perform the re-probing is made at the same visit where a separately identifiable evaluation occurs; the E/M must be documented beyond the pre-procedure assessment to withstand audit. |
| -24 | Unrelated E/M During Post-op Period | Append to an E/M code billed during the 010-day global period when the visit is for a condition completely unrelated to the probing; documentation must clearly establish the unrelated nature of the new problem. |
| -51 | Multiple Procedures | May apply when 68820 is performed on the same date as another surgical procedure on the same patient by the same surgeon; the secondary procedure is typically reduced to 50% of the allowed amount — verify CCI edits for the specific code pairing. |
| -59 | Distinct Procedural Service | Use to unbundle 68820 from another code when clinically distinct and not captured by -51 or -X{EPSU} modifiers; should be supported by documentation of a separately identifiable service not typically performed together. |
| -52 | Reduced Services | Applicable if the re-probing was initiated but could not be completed as planned (e.g., probe could not be advanced due to bony obstruction); documentation must describe what was and was not accomplished. |
| -53 | Discontinued Procedure | Use when the procedure was started but stopped due to patient safety concerns or an unexpected clinical circumstance after the start of anesthesia or patient prep; more appropriate than -52 when the procedure is wholly discontinued. |
| -58 | Staged or Related Procedure | Applies if 68820 was planned as a staged follow-up to a prior lacrimal procedure still within its global period, or if the surgeon documented pre-operatively that a second attempt would be the next step; this modifier resets the global period. |
| -78 | Return to OR — Related Procedure | Use if the patient must return to the OR during the global period of a prior lacrimal procedure specifically because of a complication related to that prior surgery (e.g., probe-related trauma requiring repeat intervention); does NOT reset the global period. |
| -79 | Unrelated Procedure During Post-op | Append when 68820 is performed during the global period of a completely unrelated prior surgical procedure by the same surgeon; this resets its own new global period for the re-probing. |
🩺 Common ICD‑10‑CM Pairings
Primary Diagnosis Group
| ICD‑10 | Description | HCC? | Notes |
|---|---|---|---|
| H04.531 | Neonatal obstruction of right nasolacrimal duct | No | Most common pediatric indication; requires laterality; must specify neonatal/congenital origin to use this code vs. acquired stenosis codes. |
| H04.532 | Neonatal obstruction of left nasolacrimal duct | No | Laterality must match the operative side and the modifier (-LT); cross-reference with prior claim’s diagnosis for documentation continuity. |
| H04.533 | Neonatal obstruction of bilateral nasolacrimal ducts | No | Use when both ducts are obstructed and both are being re-probed in the same session; pairs with modifier -50 or bilateral line items. |
| H04.541 | Stenosis of right lacrimal duct | No | Appropriate for acquired stenosis in older pediatric or adult patients; distinguishes from neonatal/congenital origin; supports medical necessity for repeat intervention. |
| H04.542 | Stenosis of left lacrimal duct | No | Laterality-specific acquired stenosis; use when the prior obstruction was not of neonatal origin and the clinical picture reflects chronic or progressive narrowing. |
Secondary Group
| ICD‑10 | Description | HCC? | Notes |
|---|---|---|---|
| H04.001 | Unspecified dacryoadenitis, right lacrimal gland | No | May be listed as a secondary diagnosis when concurrent lacrimal gland inflammation contributes to the obstruction picture; not the primary indication. |
| H04.209 | Unspecified epiphora, unspecified lacrimal gland | No | Epiphora (tearing) is the presenting symptom; when the underlying obstruction is clearly identified and coded, epiphora may be coded as an additional symptom code per ICD-10-CM guidelines — confirm it adds value to the claim before including. |
Etiology / Complication
| ICD‑10 | Description | HCC? | Notes |
|---|---|---|---|
| Q10.5 | Congenital stenosis and stricture of lacrimal duct | No | Use for congenital cases where neonatal-specific codes are not applicable or when the obstruction has a structural congenital origin; common in genetic syndromes or craniofacial anomalies. |
| H04.561 | Stenosis of right lacrimal punctum | No | Use as a secondary or etiology code when punctal stenosis is contributing to the drainage failure; punctal stenosis may be addressed separately with 68801 if distinct. |
Coding Specificity Reminder
ICD-10-CM demands full laterality specificity for lacrimal system diagnoses — never use unspecified laterality codes (e.g., H04.539 or H04.549) when the operative record clearly identifies the side(s). The diagnosis code laterality must always match the procedure code modifier (RT/LT/bilateral). For neonatal/congenital cases, H04.53x codes are preferred over Q10.5 when the obstruction is membranous at the valve of Hasner, as this is more specific; Q10.5 is appropriate when a structural congenital anomaly is identified. Always verify that the ICD-10-CM code used reflects the documented clinical diagnosis — using a symptom code like epiphora as the primary diagnosis when a definitive obstruction code exists is a coding error and a compliance risk.
🏥 MS‑DRG Considerations
CPT 68820, as a physician-side CPT code, does not directly map to an MS-DRG for inpatient facility billing; DRG assignment on the inpatient side is driven by ICD-10-PCS procedure codes, not CPT. However, in the context of inpatient professional fee (profee) coding — 68820 would be reported on a CMS-1500 claim by the operating ophthalmologist for professional reimbursement separate from the facility’s UB-04. For outpatient hospital billing (POS 22), the procedure maps to an Ambulatory Payment Classification (APC) under the OPPS; for ASC billing (POS 24), the procedure falls under an ASC payment group, and facility reimbursement is governed by the ASC fee schedule rather than the physician fee schedule. Nasolacrimal duct procedures are rarely performed in the inpatient setting, but if they were (e.g., as part of a more complex craniofacial case), the ICD-10-PCS equivalent codes (see below) would be used on the facility claim, and the associated MS-DRG would likely group to MDC 02 (Diseases and Disorders of the Eye) under surgical DRGs such as DRG 116 or 117 depending on complication/comorbidity status.
🔧 ICD‑10‑PCS Equivalents
| PCS Code | Full Description | Modality |
|---|---|---|
| 08BX7ZZ | Excision of Right Lacrimal Duct, Via Natural or Artificial Opening | Surgical — Via Natural Opening |
| 08BY7ZZ | Excision of Left Lacrimal Duct, Via Natural or Artificial Opening | Surgical — Via Natural Opening |
| 08DX7ZZ | Extraction of Right Lacrimal Duct, Via Natural or Artificial Opening | Surgical — Extraction |
| 08DY7ZZ | Extraction of Left Lacrimal Duct, Via Natural or Artificial Opening | Surgical — Extraction |
PCS Character Analysis
| Position | Character | Value | Definition |
|---|---|---|---|
| 1 | Section | 0 | Medical and Surgical — the root section for all operative procedures in ICD-10-PCS. |
| 2 | Body System | 8 | Eye — encompasses all structures of the ocular system and adnexa including the lacrimal drainage apparatus. |
| 3 | Root Operation | B (Excision) or D (Extraction) | Excision (B) is used when a portion of tissue is cut out; Extraction (D) applies when the obstruction is pulled or stripped out without cutting; probing most closely maps to Extraction given the mechanical disruption of a membrane. |
| 4 | Body Part | X (Right Lacrimal Duct) or Y (Left Lacrimal Duct) | Laterality is specified at the body part character level in PCS — right = X, left = Y; this must match the CPT claim laterality modifier. |
| 5 | Approach | 7 | Via Natural or Artificial Opening — the probe is introduced through the lacrimal punctum, a natural body opening, making approach 7 the most accurate mapping for nasolacrimal duct probing. |
| 6 | Device | Z | No Device — no hardware, drain, or stent is left in place; if a stent is placed, this character would change to D (Intraluminal Device), correlating to CPT 68815 instead. |
| 7 | Qualifier | Z | No Qualifier — no additional specificity applies to the procedure in the standard coding framework. |
Root Operation Comparison
- Extraction (D) is the most defensible root operation for nasolacrimal probing because the procedure mechanically disrupts and pulls apart membranous tissue at the valve of Hasner without cutting — the ICD-10-PCS definition of Extraction is “pulling or stripping out or off all or a portion of a body part by the use of force,” which aligns well with the probing mechanism.
- Excision (B) may be argued when the obstruction involves removal of a distinct tissue segment, but this is less common in standard probing and more applicable to cases where a tissue flap or membrane is specifically excised during a more involved open approach.
- The absence of a dedicated ICD-10-PCS root operation precisely matching “probing” reflects the known gap between CPT’s procedure-centric structure and PCS’s body part/root operation framework; facility coders should default to Extraction (D) for standard nasolacrimal duct probing and document the rationale.
📝 Coding Examples
Example 1
Clinical Scenario: A 9-month-old male presents to the ophthalmology office with persistent epiphora and mucopurulent discharge from the right eye since birth. He underwent initial right nasolacrimal duct probing with irrigation (68810-RT) at 4 months of age by the same provider, with temporary improvement, but symptoms recurred at 6 months. The physician examines the patient, confirms persistent right NLDO by fluorescein dye disappearance test, and performs a repeat probing of the right nasolacrimal duct with saline irrigation in the office under topical anesthesia. Patency is confirmed by the appearance of irrigant at the nasal meatus. A follow-up is scheduled for 2 weeks.
| Field | Code | Rationale |
|---|---|---|
| CPT | 68820-RT | 68820 applies because this is a documented repeat probing after a prior unsuccessful probing (68810-RT); the -RT modifier specifies right-side laterality and matches the ICD-10-CM diagnosis. |
| PDx | H04.531 | H04.531 — Neonatal obstruction of right nasolacrimal duct — is the appropriate primary diagnosis; it reflects the congenital/neonatal origin and provides full laterality specificity as required. |
Note
The prior 68810-RT claim date must be documented in the operative note or medical record to support the “after unsuccessful probing” descriptor of 68820; payers may request records to verify the prior attempt, particularly for pediatric claims where medical necessity review is common. Do not report 68801 (punctal dilation) separately, as it is bundled.
Example 2
Clinical Scenario: A 12-month-old female with bilateral neonatal NLDO presents for bilateral repeat nasolacrimal duct probing under general anesthesia at an ASC. Chart review confirms bilateral initial probing was performed 3 months ago with incomplete resolution bilaterally. The surgeon performs repeat probing with irrigation of both the right and left nasolacrimal ducts. No stent is placed. The anesthesiologist separately reports anesthesia services.
| Field | Code | Rationale |
|---|---|---|
| CPT 1 | 68820-50 | 68820-50 reports bilateral repeat probing; the -50 modifier triggers the 150% bilateral payment rule; confirm payer preference for -50 vs. -RT/-LT on separate lines. |
| PDx | H04.533 | H04.533 — Neonatal obstruction of bilateral nasolacrimal ducts — is the appropriate diagnosis for documented bilateral obstruction requiring bilateral re-intervention. |
Warning
Do NOT report 68811 (probing requiring general anesthesia) for this encounter — 68811 is the initial probing code for general anesthesia; the repeat probing code family does not have a GA variant, and 68820 applies regardless of anesthesia type. Submitting 68811 when a prior probing is already on file represents a coding error that could trigger a payer audit or allegation of upcoding.
Example 3
Clinical Scenario: A 3-year-old male is seen by the same ophthalmologist who performed his initial probing 6 months ago. His mother reports return of tearing in the left eye. Before the procedure, the physician performs a medically necessary evaluation of the left eye to reassess the drainage system, review the prior procedure outcome, and make the clinical decision to proceed with repeat probing. The repeat probing with irrigation is performed the same day in the office. No new diagnosis is identified beyond the recurring NLDO.
| Field | Code | Rationale |
|---|---|---|
| CPT 1 | 99213-25 or 99214-25 | A significant, separately identifiable E/M is reported with modifier -25 to distinguish it from the pre-procedure assessment inherent to 68820; the E/M must be documented beyond the routine pre-op check and must reflect clinical decision-making. |
| CPT 2 | 68820-LT | 68820 with -LT modifier for left-side repeat probing; the -25 modifier goes on the E/M, not on the surgical code. |
| PDx | H04.532 | H04.532 — Neonatal obstruction of left nasolacrimal duct — drives both the E/M and the procedure; laterality is explicit. |
Global period reminder
The 68820-LT billed today begins its own 10-day global period. Any visit within those 10 days that is related to the left eye probing is bundled and cannot be billed separately without modifier -24. If the same provider also performed a prior lacrimal procedure on this patient within the past 10 days, verify that today’s 68820 is not falling within that code’s global period before submitting — if it is, modifier -79 (unrelated) or -58 (staged) may be needed depending on clinical context.
⚠️ Common Coding Pitfalls
- Pitfall 1: Reporting 68811 instead of 68820 for repeat probing under general anesthesia. 68811 is explicitly the code for the initial probing when general anesthesia is required; once a prior probing has occurred and failed, all subsequent probings — regardless of anesthesia type — should be reported as 68820. Using 68811 for a repeat attempt when a prior 68810 or 68811 is already on file is a misrepresentation of the service and a common audit finding in pediatric ophthalmology billing.
- Pitfall 2: Failing to document the prior unsuccessful probing in the operative note. The CPT descriptor for 68820 explicitly states “after unsuccessful probing,” meaning the medical record for the 68820 encounter must reference the prior attempt — include the date, the outcome (failure to achieve patency, recurrent tearing), and the clinical rationale for repeat intervention. Without this documentation, the claim is unsupportable and subject to denial or recoupment.
- Pitfall 3: Separately billing 68801 (punctal dilation) alongside 68820. Punctal dilation is inherent to the approach for nasolacrimal probing and is subject to CCI bundling edits; reporting both 68801 and 68820 for the same eye on the same date is a CCI violation and will result in denial of 68801 unless an NCCI modifier is applicable and clinically justified — which is rarely the case here.
- Pitfall 4: Using unspecified laterality ICD-10-CM codes. Diagnosis codes like H04.539 (neonatal obstruction, unspecified) or H04.549 (stenosis, unspecified lacrimal duct) should not be used when the operative record clearly identifies the side; payers and CMS coding guidelines require the highest level of specificity, and unspecified codes when laterality is documented are a compliance risk.
- Pitfall 5: Upcoding to 68815 when no stent was placed. CPT 68815 (probing with insertion of tube or stent) has a 090-day global period and higher RVU than 68820; billing 68815 when the operative note does not document placement of a silicone tube, Crawford stent, or equivalent device constitutes upcoding. The operative report must explicitly confirm the device placed, its type, and confirmation of placement to support 68815.
- Pitfall 6: Incorrect bilateral modifier handling. Submitting two line items of 68820 (one -RT, one -LT) without notating bilateral indicators correctly, or submitting 68820 twice without any laterality distinction, can appear as duplicate billing. Know your specific MAC or commercial payer’s preference for bilateral reporting (single line with -50 vs. two lines with -RT/-LT) and confirm the payment policy before submitting to avoid automated denials.