CPT code 68110 – Conjunctival lesion excision

Key takeaways

CPT code 68110 covers complete excision of a conjunctival lesion up to 1 cm. Lesions over 1 cm require CPT 68115 instead.

Documentation must include a pre-excision measurement in centimeters, the anatomical location, and the excision technique to support code selection.

LT and RT laterality modifiers are mandatory on every 68110 claim; missing them is the leading denial trigger.

Pabau’s claims management software checks modifiers and ICD-10 pairings before submission, so fewer ophthalmic claims come back denied.

CPT code 68110: Official descriptor and clinical scope

CPT code 68110 is defined by the American Medical Association (AMA) as: Excision of lesion, conjunctiva; up to 1 cm. Every billing and documentation decision on the claim flows from its three parts: The site, the procedure type, and the size limit.

The anatomical site is the conjunctiva, the thin mucous membrane covering the sclera and lining the inner eyelids. The procedure type is excision, meaning complete removal with intent to cure, not diagnostic sampling. And the size threshold, up to 1 cm, is measured at the lesion’s greatest diameter before the specimen is removed.

Lesion types that qualify for 68110 include:

• Conjunctival papilloma
• Conjunctival cyst (H11.44x)
• Pinguecula (H11.15x), when excised rather than observed
• Ocular surface squamous neoplasia (OSSN), coded C69.0x or D09.2x depending on pathology
• Conjunctival nevus (D31.0x)
• Benign conjunctival neoplasm (D31.0x)
• Malignant conjunctival neoplasm (C69.0x)

CPT code 68110 excludes pterygium excision, which has its own code family. It also excludes lesions over 1 cm in greatest diameter, corneal lesions, and scleral procedures. Billing 68110 for a pterygium triggers an ICD-10 mismatch denial. The three questions below settle which code a conjunctival lesion takes.

CPT 68110 vs 68115: Choosing the right code by lesion size

CPT 68115 covers excision of a conjunctival lesion over 1 cm. The two codes share the same procedure type and anatomical site. The only differentiator is the pre-excision measurement. Selecting between them incorrectly, in either direction, creates upcoding or undercoding exposure.

Critical documentation point: The measurement must appear in the operative report before excision, not estimated after the specimen is removed. Pathology specimen size can shrink during fixation and does not substitute for intraoperative measurement when payers audit for code level selection.

CPT 68110 vs 68100: Excision versus biopsy

CPT 68100 is the biopsy code for the conjunctiva, covering partial removal of tissue for diagnostic purposes. CPT 68110 requires complete removal with therapeutic intent. The operative report language determines which code applies, not the tissue volume removed.

Billing 68100 and 68110 on the same date of service for the same eye requires modifier -59 to indicate a distinct procedural service. NCCI edits bundle these two codes by default. Without -59 and clear documentation that a biopsy and a separate complete excision were performed, the claim for 68100 will be denied.

How to document CPT code 68110: Operative report requirements

Auditors reviewing CPT code 68110 claims look for six specific documentation elements. Missing any one of them opens a medical necessity or code-level dispute. Work through this checklist before the claim goes out, in line with medical billing compliance standards for surgical procedures.

1. Lesion description: Clinical appearance, suspected diagnosis, and reason for surgical removal.
2. Pre-excision measurement in centimeters: State the greatest diameter explicitly (e.g., “0.7 cm lesion”). This determines whether 68110 or 68115 applies.
3. Anatomical location on the conjunctiva: Specify bulbar conjunctiva, tarsal conjunctiva, fornix, or limbal region, and note whether superior, inferior, nasal, or temporal.
4. Laterality: Right eye, left eye, or bilateral. If bilateral, document each eye separately.
5. Excision technique: State the instrument used (scissors, scalpel, laser) and note whether free margins were achieved.
6. Specimen submission: Document whether the excised tissue was sent to pathology. If submitted, the pathology CPT (typically 88305) is billed separately by the pathologist, not bundled into 68110.

Surgeons often record lesion size after excision, taken from the pathology report. Payers may reject this because fixation shrinkage alters specimen dimensions. The intraoperative measurement, captured before excision, is the defensible figure for code selection.

ICD-10 diagnosis codes paired with CPT code 68110

Selecting an ICD-10 code that does not anatomically match the conjunctival excision procedure is the second most common denial trigger after missing laterality modifiers. Review the AAPC Codify CPT lookup and the table below for the correct pairings.

What not to pair with 68110: H11.0x pterygium codes (H11.001-H11.069) must not be used with CPT 68110. Pterygium has dedicated CPT codes outside the 68110 family, such as CPT 65426. Submitting a pterygium ICD-10 code against a 68110 claim signals a procedure-diagnosis mismatch and triggers denial. Use the CrossCoder procedure-to-diagnosis crosswalk to verify ICD-10 alignment before submission.

Modifiers for CPT code 68110

The laterality modifiers RT and LT are mandatory on every 68110 claim, because the eye is a paired organ. The table below covers them alongside the five other modifiers that come up on conjunctival excisions.

For bilateral procedures, payer rules diverge. Medicare accepts modifier -50 on a single line, but many commercial payers prefer two separate line items, one with RT and one with LT. Verify each payer’s bilateral billing policy before submission. Billing a commercial payer in the Medicare format is a common source of partial payment.

CPT code 68110 reimbursement and 2026 fee schedule

Reimbursement for CPT code 68110 under Medicare is determined by the Medicare Physician Fee Schedule (MPFS). The 2026 national rates below reflect the non-facility (office) and facility (ASC or hospital outpatient) payment amounts.

Use the CMS Physician Fee Schedule Look-Up Tool to retrieve locality-adjusted rates for your area. The FastRVU 2026 RVU lookup shows the underlying work, practice expense, and malpractice RVU components.

Geographic adjustment (GAF) means a practice in Manhattan receives a higher payment than one in rural Nebraska for the same 68110 claim. Practices with multiple locations should pull locality-specific rates rather than relying on national averages.

Global period and post-operative billing

CPT 68110 carries a 10-day global period under CMS minor surgery assignment. This means routine post-operative follow-up visits within 10 days of the procedure are bundled into the surgical fee and cannot be billed separately.

Services that stay separately billable during the 10-day global period include:

• E/M services for a new problem unrelated to the surgery, appended with modifier -24 (unrelated E/M during post-op period)
• E/M for a significant and separately identifiable problem at the same visit, with modifier -25 on the same DOS as the procedure (pre-operative only)
• Staged or related procedures billed with modifier -58
• Return to OR for complications, billed with modifier -78

Payer variation exists. Some commercial payers assign a 90-day global to minor ophthalmic procedures, or apply global period rules inconsistently. Verify each payer’s global period policy in your contract before billing post-operative services separately. Assuming the CMS 10-day standard applies to all payers is a common source of recoupment.

Common denial reasons and how to avoid them

Denials on CPT code 68110 cluster around six predictable errors. The remittance advice names each one with one of the denial codes payers use, which tells you which fix applies. A structured denial management workflow then recovers the claims that still come back.

An automated pre-submission review for these six error types cuts first-pass denials on conjunctival procedure claims. A clean claim costs less in rework than an appeal. Appeal turnaround from Medicare typically runs 60-120 days.

Billing 68110 in an ASC vs office setting

Place of service directly affects how much the physician is paid for CPT code 68110. The professional fee changes with where the procedure is performed, even though the surgical work is identical.

The non-facility rate pays the physician for supplying the surgical environment, equipment, and staff. In an ASC or hospital outpatient department, the facility takes a separate payment and the physician receives the lower facility fee. A practice weighing in-office surgical capacity for conjunctival excisions has to build this difference into its overhead calculation.

ASC eligibility is also a consideration. CPT 68110 must appear on CMS’s ASC Covered Procedures List for the facility to receive an ASC facility payment. If 68110 is not on the approved list for a specific ASC, the procedure should be performed in the office or hospital outpatient setting instead. Verify ASC eligibility through the CMS ASC payment policy before scheduling.

How Pabau catches 68110 claim errors before submission

In a generic billing tool, a coder checks the laterality modifier, the lesion size and the ICD-10 pairing by eye. One missed RT or LT sends the claim back weeks later, and the appeal clock starts.

Pabau, the practice management platform we build, moves those checks ahead of submission. Its claims management software flags modifier and ICD-10 mismatches on conjunctival excision claims before they leave the practice.

Clean claims then go out through Claim.MD, Pabau’s US clearinghouse integration, which routes to thousands of US payers. It also verifies eligibility before the procedure date, so coverage problems surface while the patient can still reschedule.

Streamline your ophthalmic billing workflow

Pabau’s claims management software validates CPT codes, modifiers, and ICD-10 pairings before submission, so your conjunctival excision claims go out clean the first time.

Book a demo

Conclusion

Code 68110 from the operative report, never from memory or the pathology slip. A report that records a pre-excision size, a laterality and a non-pterygium diagnosis gives the payer every reason to pay.

The work sits with the surgeon, and it takes seconds in the OR. Skipping it costs far more, because a Medicare appeal typically runs 60-120 days.

Book a demo to see how Pabau checks modifiers and ICD-10 pairings on your ophthalmic claims before they go out.

Continue your research

Need to understand how clearinghouse submissions work for surgical codes? Medical claims clearinghouse explained covers how claims route from practice to payer and where edits are applied.

Building the encounter form for surgical visits? Superbill documentation best practices walks through the fields that support clean claim submission for surgical procedures.

Looking to verify eligibility before scheduling conjunctival excision procedures? Insurance eligibility verification explains how real-time eligibility checks reduce post-service billing surprises.

Removing a lesion from the eyelid rather than the conjunctiva? CPT code 67840 covers eyelid lesion excision and the documentation it needs.

Frequently asked questions