CPT code 68810 – Nasolacrimal duct probing billing guide

Key takeaways

CPT code 68810 covers nasolacrimal duct probing, with or without irrigation, when the procedure does not require general anesthesia.

Anesthesia type decides the code: 68810 for local or topical anesthesia, 68811 when general anesthesia is required.

A stent or tube left in place moves the claim to 68815, and balloon catheter dilation moves it to 68816.

Medicare (e.g., CGS) bills a bilateral probing on one line with modifier -50, while -RT and -LT report the side of a unilateral service.

Pabau, the practice management platform we build, submits and tracks claims electronically through its Claim.MD integration.

CPT code 68810: official descriptor and procedure overview

CPT code 68810 describes probing of the nasolacrimal duct, with or without irrigation, when the procedure does not require general anesthesia. A blunt metal probe passes through the punctum, along the canaliculus and lacrimal sac, and into the nasolacrimal duct to open a membranous obstruction.

The procedure is performed under local or topical anesthesia, typically in an office or ambulatory setting. Stent placement, balloon catheter dilation or general anesthesia each move the claim to a different code.

According to the American Medical Association’s CPT code set, 68810 sits in the lacrimal system procedures (68400-68899) of the eye and ocular adnexa surgery section. It is most often performed on infants with congenital nasolacrimal duct obstruction (NLDO).

Probing typically follows several months of failed conservative management, but the timing criteria belong to each payer, so verify them before scheduling. A grasp of medical billing fundamentals for surgical codes helps ophthalmology practices avoid the documentation errors that lead to 68810 denials.

The quick-reference table below captures the core billing parameters for this code.

What the procedure includes and excludes

Irrigation is part of the 68810 descriptor (“with or without irrigation”), so irrigation in the same session is not separately reportable. Punctal dilation done to pass the probe is bundled as well.

Bundled into 68810 (do not bill separately):

• Punctal dilation performed immediately before probing in the same session (68801 is not billed alongside 68810 for the same duct on the same date)
• Irrigation of the nasolacrimal duct performed during the same session
• Topical or local anesthetic administration

Not included in 68810 (report a different code, or bill separately):

• Stent or intubation tube placement: report 68815 instead
• Transluminal balloon catheter dilation: report 68816 instead
• Probing under general anesthesia: report 68811 instead (anesthesia professional services are billed separately)
• Dacryocystorhinostomy (DCR): report 68720
• Separate, significant evaluation and management service on the same day (modifier -25 required)

CPT 68810 vs 68811: anesthesia type is the deciding factor

CPT 68811 is the code for nasolacrimal duct probing requiring general anesthesia. Anesthesia type, not patient age, determines which code to bill. A toddler probed in the office under topical drops is 68810. That same child probed in an OR under general anesthesia is 68811. Age matters only as a medical necessity criterion for prior authorization, not for code selection.

The operative note must state the anesthesia type used. A note that names neither local nor topical anesthesia leaves the choice between 68810 and 68811 unsupported, which invites a records request on audit.

CPT 68810 vs 68815: when stent placement changes the code

CPT 68815 covers probing of the nasolacrimal duct with insertion of a tube or stent. When a silicone bicanalicular stent or monocanalicular tube is left in place at the end of the procedure, 68815 replaces 68810 entirely. The two codes cannot be billed together for the same duct on the same date.

Stent placement is typically indicated after a failed first probing or a more proximal obstruction. It is also used when the surgeon anticipates a higher recurrence risk. The decision is made intraoperatively, so the note must document both the probing and the rationale for tube insertion. Billing 68810 when a stent was placed is a downcoding error. Billing both is an unbundling error.

Neighboring lacrimal system codes: knowing when to use each

The lacrimal code family covers a narrow range of related procedures. Confusing them leads to either upcoding audits or lost revenue from undercoding. For the four nasolacrimal probing codes, three questions settle the choice, asked in the order shown below.

ICD-10 codes paired with CPT code 68810

Payers validate medical necessity by cross-checking the diagnosis code against the procedure. A non-covered diagnosis triggers a denial regardless of how complete the operative note is. The table below lists the ICD-10-CM codes most often paired with 68810.

For Medicare in Jurisdiction 15 (Kentucky and Ohio), CGS’s local coverage determination (LCD) L34171 sets the coverage criteria for nasolacrimal duct probing. Other Medicare Administrative Contractors (MACs) may publish different policies or none, so check your MAC’s LCD before submission.

Where an LCD applies, confirm the diagnosis on the claim appears on its covered-diagnosis list. Avoid the unspecified H04.9 code when the record names the duct and the side, because payers expect the most specific diagnosis available.

Medicare reimbursement for CPT code 68810

Reimbursement for 68810 varies by place of service, geographic adjustment factor and MAC. Non-facility rates (office, POS 11) are typically higher than facility rates (ASC POS 24 or hospital outpatient POS 19/22). That is because the practice absorbs the overhead costs in a non-facility encounter.

Use the CMS Medicare Physician Fee Schedule look-up tool to retrieve current-year non-facility and facility payment amounts for your MAC jurisdiction. Published rates change with each January fee schedule (MPFS) update, so hardcoded figures in billing guides go stale quickly.

Commercial rates vary by contract, often benchmarked to the MPFS. Practices billing 68810 through Pabau can submit claims electronically via its Claim.MD clearinghouse integration. Claim.MD runs eligibility checks and submits claims to thousands of US payers.

The FastRVU 2026 look-up tool shows the work, practice expense and malpractice relative value units (RVUs) for 68810 at no cost. Its figures come from the published CMS data file.

Modifiers for CPT code 68810

Modifier selection for 68810 depends on laterality, whether the procedure is bilateral, and any global period considerations. Incorrect modifier use is a common reason 68810 claims are rejected. Pabau’s electronic claims management submits each claim with its modifiers and tracks its status, so a rejection surfaces quickly.

Medicare (e.g., CGS) bills a bilateral service on one line with -50, and -RT or -LT apply to a unilateral service. Some payers want two lines with -RT and -LT instead, so verify payer policy before billing.

Documentation requirements payers require for CPT 68810

An operative note for 68810 must contain more than “nasolacrimal duct probing performed.” Payers need evidence that the procedure was medically necessary and that the record supports the code billed. In Jurisdiction 15, CGS’s LCD L34171 sets that standard for Medicare.

• Conservative treatment failure: document the duration of nasolacrimal massage and any topical antibiotic use before probing was scheduled. Probing typically follows several months of failed conservative management, per payer policy, so verify the payer or LCD criteria.
• Patient age: age affects medical necessity review. Note the patient’s date of birth in the operative record.
• Anesthesia type used: state explicitly that local or topical anesthesia was administered, not general. This is the detail that separates 68810 from 68811.
• Laterality: document which duct (right, left, or bilateral) was probed. This must match the modifier on the claim.
• Intraoperative findings: note the resistance encountered, the level of obstruction, and whether probing was successful.
• Irrigation: if irrigation was performed, note it in the operative record even though it is included in the code. Some payers cross-reference this during audit.

Prior authorization and medical necessity criteria

For Medicare in Jurisdiction 15 (Kentucky and Ohio), CGS’s LCD L34171 sets the coverage framework for nasolacrimal duct probing. Other MACs may publish different policies or none, so check your MAC’s LCD. Commercial payers set their own criteria, which often start with documented failure of conservative management.

Prior authorization requirements vary by payer and can depend on the setting. Check them at scheduling, not on the day of the procedure, as part of a structured prior authorization process. Follow clean claim submission practices so authorization numbers are attached at submission, not added on appeal.

Common claim denial reasons and how to fix them

Most 68810 denials fall into a predictable set of categories. Effective denial management workflows track these patterns and catch them before the claim leaves the practice. The specific medical billing denial codes on each rejection tell you whether to correct and resubmit or file a formal appeal.

How Pabau supports clean claims for CPT 68810

Claims for 68810 tend to fail on details set before submission: the side, the diagnosis and the authorization number. Without a connected system, staff re-key each claim into a payer portal and chase its status by phone.

Pabau’s claims management, with Claim.MD, submits claims electronically from the patient’s billing record and tracks each one after it leaves. Eligibility checks run through the same integration, so coverage can be confirmed the day before the procedure.

The result is fewer re-keyed claims and a clear view of which 68810 claims are paid, pending or denied.

Submit and track ophthalmology claims electronically

Pabau’s claims management, with Claim.MD, submits and tracks claims electronically, so your team can see where every CPT 68810 claim stands.

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Conclusion

Once the operative note states the anesthesia type and whether a stent or balloon was used, the code choice for 68810 is straightforward. The harder work sits upstream, in confirming the payer’s timing criteria and authorization before the patient is booked.

Settle the side, the diagnosis and the authorization at scheduling, and the denial reasons above have little left to catch. Book a demo to see how Pabau submits and tracks lacrimal probing claims electronically, from eligibility check to payment.

Continue your research

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Frequently asked questions