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Official Description

Conjunctivorhinostomy (fistulization of conjunctiva to nasal cavity); without tube

© Copyright 2025 American Medical Association. All rights reserved.

Common Language Description

Conjunctivorhinostomy is a surgical procedure designed to address epiphora, which is characterized by excessive tearing due to obstructions in the upper lacrimal structures, specifically the punctum and canaliculi. This condition can significantly impact a patient's quality of life, leading to discomfort and potential complications if left untreated. During the procedure, an incision is made in the lower lid conjunctival sac, allowing the surgeon to raise mucosal flaps. The next critical step involves perforating the frontal process of the maxillary bone to create a direct passageway between the conjunctival sac and the nasal fossa. This connection facilitates the drainage of tears directly into the nasal cavity, thereby alleviating the symptoms associated with the blockage. It is important to note that this specific code, CPT® 68745, refers to the conjunctivorhinostomy performed without the placement of a tube, distinguishing it from similar procedures that may involve additional components such as tube insertion for enhanced drainage.

© Copyright 2025 Coding Ahead. All rights reserved.

1. Indications

Conjunctivorhinostomy is indicated for patients experiencing epiphora due to obstruction of the upper lacrimal structures. The following conditions may warrant this surgical intervention:

  • Epiphora Excessive tearing resulting from blockages in the lacrimal drainage system, particularly affecting the punctum and canaliculi.
  • Lacrimal duct obstruction Blockage in the nasolacrimal duct that prevents normal tear drainage.
  • Chronic dacryocystitis Inflammation of the lacrimal sac, often due to infection or obstruction, leading to persistent tearing and discomfort.

2. Procedure

The conjunctivorhinostomy procedure involves several key steps to ensure successful creation of a passageway for tear drainage. The following outlines the procedural steps:

  • Step 1: Anesthesia The procedure typically begins with the administration of local anesthesia to ensure patient comfort during the surgery. In some cases, general anesthesia may be used depending on the patient's needs and the complexity of the case.
  • Step 2: Incision A careful incision is made in the lower lid conjunctival sac. This incision allows access to the underlying structures and is crucial for the subsequent steps of the procedure.
  • Step 3: Mucosal Flap Creation The surgeon raises mucosal flaps from the conjunctival sac, which will later be used to create the connection to the nasal cavity.
  • Step 4: Bone Perforation The frontal process of the maxillary bone is then perforated. This step is essential as it opens a passageway between the conjunctival sac and the nasal fossa, facilitating the drainage of tears.
  • Step 5: Passageway Formation The surgeon ensures that the newly created passageway is adequately formed to allow for the free flow of tears from the conjunctival sac into the nasal cavity.
  • Step 6: Closure Finally, the mucosal flaps are sutured in place to secure the new connection, ensuring that the passageway remains open for effective tear drainage.

3. Post-Procedure

After the conjunctivorhinostomy procedure, patients may experience some swelling and discomfort in the surgical area. Post-operative care typically includes the use of prescribed analgesics to manage pain and anti-inflammatory medications to reduce swelling. Patients are advised to avoid strenuous activities and to follow up with their healthcare provider for monitoring the healing process. It is also important to maintain proper hygiene around the surgical site to prevent infection. The expected recovery time may vary, but most patients can anticipate a gradual improvement in symptoms as the surgical site heals and the new drainage pathway becomes functional.

Short Descr CREATE TEAR DUCT DRAIN
Medium Descr CONJUNCTIVORHINOSTOMY W/O TUBE
Long Descr Conjunctivorhinostomy (fistulization of conjunctiva to nasal cavity); without tube
Status Code Active Code
Global Days 090 - Major Surgery
PC/TC Indicator (26, TC) 0 - Physician Service Code
Multiple Procedures (51) 2 - Standard payment adjustment rules for multiple procedures apply.
Bilateral Surgery (50) 1 - 150% payment adjustment for bilateral procedures applies.
Physician Supervisions 09 - Concept does not apply.
Assistant Surgeon (80, 82) 2 - Payment restriction for assistants at surgery does not apply to this procedure...
Co-Surgeons (62) 1 - Co-surgeons could be paid, though supporting documentation is required...
Team Surgery (66) 0 - Team surgeons not permitted for this procedure.
Diagnostic Imaging Family 99 - Concept Does Not Apply
APC Status Indicator Hospital Part B services paid through a comprehensive APC
ASC Payment Indicator Surgical procedure on ASC list in CY 2007; payment based on OPPS relative payment weight.
Type of Service (TOS) 2 - Surgery
Berenson-Eggers TOS (BETOS) P4E - Eye procedure - other
MUE 1
CCS Clinical Classification 19 - Other therapeutic procedures on eyelids, conjunctiva, cornea
LT Left side (used to identify procedures performed on the left side of the body)
RT Right side (used to identify procedures performed on the right side of the body)
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Pre-1990 Added Code added.
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