Billing and Coding: Nasal Punctum-Nasolacrimal Duct Dilation and Probing with or without Irrigation

Medicare covers nasal punctum and nasolacrimal duct dilation and probing (CPT 68801, 68810-68815, 68840) when reasonable and necessary with appropriate diagnosis coding and documentation; coverage is allowed in specified places of service under Part B and subject to Part A billing rules for hospitals. Billing requirements include use of site modifiers (LT/RT or -50 for bilateral), adherence to a 10-day global period, single payment for 68801 per eye, restrictions on same-day billing of 68801 with probing codes, compliance with NCCI/OPPS edits, and submission of required documentation including signed operative/office notes, referring physician NPI when applicable, and ABN documentation when non-coverage is anticipated.

"CPT codes 68801, 68810 and 68840 are payable under Medicare Part B when medically necessary and performed in the following places of service: office (11), assisted living facility (13), inpatient h..."