Ophthalmology Coding Alert

You Be the Coder: Nasolacrimal Duct Obstruction


- Published on Sun, Sep 01, 2002
Test your coding knowledge. Determine how you would code this situation before looking at the box below for the
answer.

Question: A child presented with an NLD obstruction in her left eye. However, my ophthalmologist documented probing both eyes. How should I code for this?

Alabama Subscriber

 

       

Answer: Coding the procedure won't be as difficult as you might expect once you eliminate any inclinations to code for the probing of both nasolacrimal ducts (NLDs). The physician's motivation to probe both ducts is not expressed by the diagnosis of an obstruction in one eye. If there is only one diagnosis of a nasolacrimal duct obstruction (375.55, Obstruction of nasolacrimal duct, neonatal; 375.56, Stenosis of nasolacrimal duct, acquired; or 743.65, Specified congenital anomalies of lacrimal passages), the probing of the second eye may be considered not medically necessary by the patient's insurance.

In this case, if there was not a finding or diagnosis documented to substantiate the medical necessity for probing the right eye, you would append the left eye modifier, -LT, and bill only one eye, with the most accurate of the codes for nasolacrimal duct probe:

  • 68810* Probing of nasolacrimal duct, with or without irrigation
  • 68811 requiring general anesthesia
  • 68815 with insertion of tube or stent.

    The other option is to bill the right eye with whatever diagnosis was documented that day, receive a denial, and bill the patient for the procedure.




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