2014 Coding


2014 DacryoCath® Reimbursement Coding



CPT Codes


Dacryocystoplasty (DCP) procedure involves probing of the lacrimal apparatus with a Bowman probe followed by the DacryoCath® balloon catheter.


·        CPT 68816, Probing of the nasolacrimal duct, with or without irrigation,   

with transluminal balloon catheter dilation


Add-on Codes


It may also be necessary to report the following codes when performed:


            CPT 68840, Probing and/or irrigation of canaliculus


·          CPT 30930, Fracture of nasal turbinate(s), therapeutic


·              CPT 31231, Nasal endoscopy

           CPT 92018, Ophthalmologic examination and evaluation, under general anesthesia, with or without manipulation of globe for passive range of motion or other manipulation to facilitate diagnostic examination; complete


Use of Modifiers


Each insurer will have the final say according to their policies and restrictions. Modifiers may be appended to 68815 and 68816 if the clinical circumstances justify the use of the modifier. There are certain modifiers that can be used under appropriate clinical circumstances.


Modifier – 50 is used to indicate a bilateral procedure.


Modifier – 58 may be used when both balloon dilation and stent placement is done at the same operative setting. In this scenario, the coding would be 68816 or 68815-58.


Dacryocystorhinostomy (DCR) procedure is more extensive and is performed in cases of lacrimal stenosis where prior treatment failed or was not fully successful. Codes to report this might include:


·          CPT 31239, Nasal/sinus endoscopy, surgical; with

Dacryocystorhinostomy, the 5mm balloon catheter is used with

Endoscopic DCR




C-Codes are used in the outpatient setting for Medicare only. Hospitals are encouraged to report all appropriate codes.


·          HCPCS C1726, Catheter, balloon dilation, nonvascular


This code, if applicable can be used for billing all payers and all patient settings.

Each insurer will have the final say according to their policies and restrictions, and may require documentation


·          HCPCS A4649, Surgical supply; miscellaneous






The information provided is general information only; it is not legal advice, nor is it advice about how to code, complete or submit any particular claim for payment. It is always the provider’s responsibility to determine and submit appropriate codes, charges, modifiers, and bills for the services that were rendered. Coding and reimbursement information is subject to change without notice. Before filing any claim, providers should verify current requirements and policies with the payor.