081X3K3
Bypass Lacrimal Duct, Right to Nasal Cavity with Nonautologous Tissue Substitute, Percutaneous Approach
Procedural Specifications
| Clinical Axis | Detail Definition |
|---|---|
| Section | 0 Medical and Surgical |
| Body System | 8 Eye |
| Operation | 1 Bypass |
| Body Part | X Lacrimal Duct, Right |
| Approach | 3 Percutaneous |
| Device | K Nonautologous Tissue Substitute |
| Qualifier | 3 Nasal Cavity |
Operation Definition
Altering the route of passage of the contents of a tubular body part
Procedure Overview
This family covers procedures that create a new pathway for fluid within the eye, most often to manage glaucoma when standard treatments have not controlled eye pressure. The eye continuously produces a clear fluid called aqueous humor, and in glaucoma this fluid drains too slowly, building up pressure that can damage the optic nerve and threaten vision. A bypass procedure reroutes that fluid around the eye's natural, poorly functioning drainage angle to a new outflow location, typically by implanting a small tube or valve device that channels aqueous humor to a reservoir beneath the eye's outer surface.
Surgeons turn to these procedures, sometimes called glaucoma drainage device or aqueous shunt implantation, when medications and laser treatment have failed to keep pressure at a safe level, or when a patient's anatomy makes more conventional filtering surgery unlikely to succeed. The goal is not to cure glaucoma but to protect remaining vision by keeping pressure within a target range over the long term.
Anatomy & Axis Detail
Lacrimal Duct, Right
The right lacrimal duct (nasolacrimal duct) drains tears from the lacrimal sac into the nasal cavity, and obstruction of this narrow passage causes chronic epiphora and recurrent dacryocystitis. A bypass here is performed when the natural drainage channel is scarred or blocked beyond what dilation or probing can fix, most often as a dacryocystorhinostomy that creates a new conduit, sometimes with a silicone or Pyrex tube, connecting the lacrimal sac directly to the nasal mucosa. Because the duct runs through the bony nasolacrimal canal alongside the maxilla and inferior turbinate, the approach may be external (via a skin incision near the medial canthus) or endonasal, and documentation should specify the route and any stent placement, since these affect the qualifier and device value selected for coding.
Approach: Percutaneous
Percutaneous describes entry by needle or instrument puncture through the skin or mucous membrane to reach the site of the procedure, without cutting the tissue open or using a visualizing scope. It differs from Open in that the site itself is never exposed, and from Percutaneous Endoscopic in that no endoscope is used to see internal structures. Common examples include needle biopsies and injections.
Device: Nonautologous Tissue Substitute
Nonautologous Tissue Substitute refers to biologic material sourced from a donor or another species, such as an allograft or xenograft, used to replace a body part. It differs from Autologous Tissue Substitute by tissue origin outside the patient's own body, and from Synthetic Substitute by being biologic rather than manufactured material.
Qualifier: Nasal Cavity
This qualifier designates the nasal cavity as a related anatomic site, most often used where a procedure elsewhere, such as on the ethmoid sinus or nasolacrimal duct, involves or communicates with the nasal passage. It differs from qualifiers naming specific sinuses by referring to the open airway space rather than an enclosed cavity.
Coding & Documentation
Code assignment hinges on the operative note specifying that a device was implanted to establish a new conduit for aqueous humor, along with the qualifier identifying where that fluid is being routed to, such as the subconjunctival space or an external collection reservoir. Documentation should also state which eye and, when relevant, which specific quadrant or structure served as the origin point of the bypass. A common assignment error is defaulting to a drainage or dilation code when the operative report actually describes a device creating a permanent alternate route rather than simply releasing trapped fluid or widening an existing passage. Coders should also confirm the device value matches what was actually implanted, since tube shunts and newer micro-stent devices are captured differently.