Crystal's Coder Hub👁️ CPT 65280 — Repair of Laceration; Cornea and/or Sclera, Perforating, Not Involving Uveal Tissue
Quick Reference
wRVU: 11.52 | Global Period: 090 (90 days) | Assistant Payable: ✅ Yes | Bilateral Indicator: 1
📋 Clinical Description
CPT 65280 describes the primary surgical closure of a full-thickness (perforating) wound of the anterior segment of the eye, specifically involving the cornea, the sclera, or both. The surgeon meticulously aligns the jagged or straight wound edges and closes them using fine sutures (typically 10-0 nylon) under an operating microscope to restore the globe’s structural integrity and achieve a watertight seal. This code is distinct from its closest sibling code, 65285, because the laceration does not involve uveal tissue (there is no prolapse, incarceration, or direct trauma to the iris, ciliary body, or choroid that requires simultaneous repair, repositioning, or excision).
Perforating Ocular Laceration is an open globe injury where a sharp object or high-velocity projectile penetrates the full thickness of the eye wall (cornea or sclera). If left untreated, an open globe leads to loss of intraocular contents, severe intraocular infection (endophthalmitis), profound visual loss, and potential loss of the eye itself.
This procedure may be performed in the following clinical contexts:
- Acute penetrating trauma — Immediate closure of a corneal laceration sustained from shattered glass, a knife, or a sharp tool.
- Iatrogenic wound leak — Repair of a surgical wound (e.g., from a previous cataract or glaucoma surgery) that has re-opened and is leaking aqueous fluid.
- Blunt rupture of the globe — Closure of a scleral rupture caused by severe blunt trauma where the underlying uvea remains intact and completely inside the eye.
- Post-foreign body extraction — Suturing the entry wound immediately following the removal of a deep intraocular foreign body (e.g., 65260).
- Severe corneal ulceration with perforation — Suturing or reinforcing a spontaneously perforated cornea secondary to severe infection or melting.
🔬 Anatomical & Procedural Considerations
| Modality/Technique Variant | Mechanism or Steps | Key Clinical or Coding Notes |
|---|---|---|
| Microscopic Suturing (Cornea) | Placement of 10-0 nylon interrupted sutures through the corneal stroma, avoiding the endothelium. | Requires an operating microscope. Knots are typically buried in the stroma to minimize irritation. |
| Microscopic Suturing (Sclera) | Conjunctiva is opened (peritomy) to expose the scleral laceration; 8-0 or 9-0 sutures (e.g., Vicryl, nylon) are placed. | Conjunctival closure is bundled into the scleral repair. Do not report a separate conjunctival repair code. |
| Tissue Adhesive / Cyanoacrylate | Application of medical-grade tissue glue to seal small, self-sealing, or pinpoint perforations. | Some payers consider simple glue application without suturing to be unlisted or lower-level E/M, but if it replaces the need for suturing a true perforation, it is generally mapped to 65280. Check payer policy. |
Clinical Pearl
Always read the operative note carefully for mentions of “iris prolapse,” “abscission of iris,” or “repositioning of the uvea/iris/ciliary body.” If the uveal tissue herniates through the laceration and the surgeon must push it back in (reposition) or cut it off (excise) before closing the cornea or sclera, you must upcode the service to 65285. If the uvea is completely untouched and intact, 65280 is the correct code.
✅ Procedure Includes
- Pre-procedure examination under anesthesia or sedation
- Anesthesia type included — Local infiltration, regional block (retrobulbar/peribulbar), or general anesthesia
- Exploration of the wound and anterior segment evaluation
- Debridement of necrotic or damaged corneal/scleral edges
- Core procedural step — Suturing the corneal or scleral laceration
- Intraoperative assessment — Reformation of the anterior chamber with balanced salt solution (BSS) or viscoelastic, and Seidel testing (using fluorescein dye) to ensure a watertight seal
- Post-procedure step — Subconjunctival injection of antibiotics/steroids, patching, and placement of a rigid eye shield
❌ Excludes / Do Not Report Together
| Code | Description | Relationship to 65280 |
|---|---|---|
| 65285 | Repair of laceration; cornea and/or sclera, perforating, with reposition or resection of uveal tissue | Mutually exclusive. Describes the same anatomic site and core procedure but involves the more complex management of uveal tissue. Report one or the other. |
| 65270 | Repair of laceration; conjunctiva, with or without nonperforating laceration sclera, direct closure | Bundled. The repair of the overlying conjunctiva is inherently included when repairing a perforating scleral laceration in the same eye. |
| 66020 | Injection, anterior chamber of eye | Bundled. Reforming the anterior chamber with fluid or air is a standard, included component of an open globe repair. |
| 65205 | Removal of foreign body, external eye | Bundled into the more extensive repair if performed at the same operative site. |
| E/M codes (992xx / 920xx) | Office visit or emergency department visit, any level | Separately reportable only when modifier -25 or -57 is appended to the E/M code, documenting a significant, separately identifiable evaluation or the decision for surgery. |
Bundling Alert — Global Period is 090, Not 010
CPT 65280 is a major surgical procedure carrying a 90-day global period. This includes all routine postoperative care, such as suture removal, IOP checks, and standard healing evaluations. Any E/M visits within this 90-day window must be strictly related to a different diagnosis or complication requiring an unplanned return to the OR to be payable. Include modifier -24 for unrelated E/M visits within the global window and ensure documentation supports the distinct diagnosis.
🌳 Code Tree — Surgery: Eye and Ocular Adnexa
CPT 65091-68899 Surgery: Eye and Ocular Adnexa
│
├── 65270-65286 Repair of Laceration (Eye)
│ ├── 65270 Repair of laceration; conjunctiva, with or without nonperforating laceration sclera, direct closure
│ ├── 65272 Repair of laceration; conjunctiva, by mobilization and rearrangement, without hospitalization
│ ├── 65275 Repair of laceration; cornea, nonperforating, with or without removal foreign body (Global: 010)
│ ├── ▶▶ 65280 ◀◀ Repair of laceration; cornea and/or sclera, perforating, not involving uveal tissue ← YOU ARE HERE (Global: 090)
│ ├── 65285 Repair of laceration; cornea and/or sclera, perforating, with reposition or resection of uveal tissue (Global: 090)
│ └── 65286 Repair of laceration; application of tissue glue, wounds of cornea and/or sclera (Global: 010)
💰 RVU & Reimbursement Profile
| Component | Value |
|---|---|
| Work RVU (wRVU) | 11.52 (verify against current CMS MPFS for applicable year) |
| Global Period | 090 |
| Bilateral Indicator | 1 |
| Assistant Surgeon | ✅ Payable |
| Co-Surgeon | ❌ Not Applicable |
| Team Surgery | ❌ Not Applicable |
| PC/TC Split | ❌ No — Procedure Code Only |
| Modifier -51 Exempt | ❌ No |
| Anesthesia | General or monitored anesthesia care (MAC) with retrobulbar block; 00140 (Anesthesia for procedures on eye; not otherwise specified) |
Bilateral Billing Rules
CPT 65280 has a bilateral indicator of 1, meaning standard bilateral rules apply. When performed on both eyes in the same session, report on a single line with modifier -50 (e.g.,
65280-50at 1 unit) or two separate lines using laterality modifiers depending on MAC preference. Medicare’s 150% bilateral rule applies: 100% of the allowable for the first eye, and 50% for the second eye.
🏷️ Modifier Reference
| Modifier | Name | When to Apply |
|---|---|---|
| -RT | Right Side | Procedure performed on the right eye. |
| -LT | Left Side | Procedure performed on the left eye. |
| -50 | Bilateral Procedure | Procedure performed on both eyes during the same session. |
| -25 | Significant, Separately Identifiable E/M | Applied to the E/M code when a separate, medically necessary evaluation is performed on the same date (note: for a major surgery, modifier -57 ‘Decision for Surgery’ is usually more appropriate for the E/M determining the need for a 90-day global procedure). |
| -24 | Unrelated E/M During Postoperative Period | Applied to the E/M code when a patient returns within the 90-day global window for an entirely unrelated eye condition or problem. |
| -51 | Multiple Procedures | When 65280 is performed alongside other distinct surgical procedures at the same session; apply to the lower-valued code. |
| -59 | Distinct Procedural Service | When payers inappropriately bundle 65280 with another procedure; documents distinct anatomic site (e.g., different eye) or independent service. |
| -78 | Unplanned Return to OR | Used if the patient develops a complication (e.g., wound leak, endophthalmitis) requiring a return to the operating room during the 90-day global period of the initial repair. |
| -79 | Unrelated Procedure During Postoperative Period | Used if the laceration repair is performed during the global period of a completely unrelated prior surgery (e.g., patient falls and ruptures globe 2 weeks after an eyelid blepharoplasty). |
🩺 Common ICD-10-CM Pairings
Penetrating Ocular Trauma Without Prolapse of Intraocular Tissue**
| ICD-10 Code | Description | HCC? | Clinical Notes |
|---|---|---|---|
| S05.31XA | Ocular laceration without prolapse or loss of intraocular tissue, right eye, initial encounter | ❌ No | Most accurate match for 65280 (no uveal tissue involvement) on the right eye. |
| S05.32XA | Ocular laceration without prolapse or loss of intraocular tissue, left eye, initial encounter | ❌ No | Most accurate match for 65280 on the left eye. |
| S05.30XA | Ocular laceration without prolapse or loss of intraocular tissue, unspecified eye, initial encounter | ❌ No | Avoid unspecified laterality whenever possible. |
Puncture Wound with Foreign Body**
| ICD-10 Code | Description | HCC? | Clinical Notes |
|---|---|---|---|
| S05.51XA | Penetrating wound with foreign body of right eyeball, initial encounter | ❌ No | Use if the object that caused the laceration is still inside the eye and is removed concurrently. |
| S05.52XA | Penetrating wound with foreign body of left eyeball, initial encounter | ❌ No | Penetrating wound with FB, left eye. |
Underlying Etiology / External Cause Codes**
| ICD-10 Code | Description | HCC? | Clinical Notes |
|---|---|---|---|
| W44.A1XA | Paper, glass and other non-biological materials entering into or through a natural orifice, initial encounter | ❌ No | External cause code detailing how the injury occurred. |
| W20.8XXA | Other cause of strike by thrown, projected or falling object, initial encounter | ❌ No | Projectile injury external cause code. |
Coding Specificity Reminder**
The most common specificity gap for this code’s ICD-10-CM pairings is the omission of the 7th character for the episode of care (A for initial encounter) and the failure to distinguish between “with prolapse” (S05.2-) versus “without prolapse” (S05.3-). ICD-10-CM specificity requirements are not optional; an unspecified 7th character will cause an immediate claim denial. Ensure an external cause code (V, W, X, or Y code) is also appended to describe the mechanism of the trauma.
🏥 MS-DRG Considerations (Inpatient)
Inpatient Coding Reminder CPT 65280 is performed primarily in the outpatient / hospital ASC setting, but severe ocular trauma often requires an inpatient admission, especially if associated with polytrauma or if intravenous antibiotics are required for endophthalmitis prophylaxis. When this procedure drives an inpatient admission, it maps to MDC 02 (Diseases and Disorders of the Eye) and the DRG family 116 (Intraocular Procedures with CC/MCC) or 117 (Intraocular Procedures without CC/MCC). The principal diagnosis of S05.31XA combined with CPT code 65280 typically groups to DRG 117, unless a major systemic comorbidity is present.
🔧 ICD-10-PCS Equivalents (Inpatient Facility Coding)
Note
Inpatient PCS coding is frequently encountered for open globe injuries treated in a trauma center. The PCS root operation for closing a laceration without removing or replacing tissue is “Repair”.
| PCS Code | Full Description | Applicable Modality |
|---|---|---|
| 08Q80ZZ | Repair Right Cornea, Open Approach | Primary suturing of right corneal laceration. |
| 08Q90ZZ | Repair Left Cornea, Open Approach | Primary suturing of left corneal laceration. |
| 08QA0ZZ | Repair Right Sclera, Open Approach | Primary suturing of right scleral laceration. |
| 08QB0ZZ | Repair Left Sclera, Open Approach | Primary suturing of left scleral laceration. |
PCS Character Analysis — 08Q80ZZ
- Section: 0 (Medical and Surgical)
- Body System: 8 (Eye)
- Root Operation: Q (Repair — Restoring, to the extent possible, a body part to its normal anatomic structure and function)
- Body Part: 8 (Cornea, Right)
- Approach: 0 (Open)
- Device: Z (No Device)
- Qualifier: Z (No Qualifier)
PCS Root Operation: Repair vs. Excision:
- Use Repair (Q) when simply suturing the laceration closed (maps to CPT 65280).
- Use Excision (B) or Reposition (S) on the Iris/Uvea if the surgeon must cut away necrotic prolapsed iris or push it back into the eye (which would crosswalk to CPT 65285).
📝 Coding Examples
Example 1 — Outpatient Hospital: Penetrating Corneal Laceration Clinical Scenario: A 28-year-old male is rushed to the hospital after a wire snapped and struck his left eye. Examination shows a 4 mm full-thickness, linear corneal laceration with a flat anterior chamber. The iris is deeply bowed backwards but is entirely intact without herniation into the wound. The patient is taken to the OR. Under general anesthesia, the wound edges are approximated and closed with five interrupted 10-0 nylon sutures. The anterior chamber is reformed with BSS, and the wound is Seidel negative.
| Field | Code | Rationale |
|---|---|---|
| CPT | 65280-LT | Primary repair of a perforating corneal laceration without uveal involvement; left eye. |
| PDx | S05.32XA | Ocular laceration without prolapse of intraocular tissue, left eye, initial encounter. |
Note
Because the patient was taken directly from the ED to the OR, the ED physician bills the E/M. The ophthalmologist bills the surgery. No modifier -25 is needed on the surgical claim.
Example 2 — ASC: Scleral Rupture During Global Period Clinical Scenario: A 72-year-old female tripped and fell, suffering blunt trauma to her right eye two weeks after an uncomplicated right eye cataract extraction. She presents with severe subconjunctival hemorrhage and low intraocular pressure. In the OR, a conjunctival peritomy reveals a 5 mm scleral rupture just posterior to the limbus. The uvea is intact beneath the sclera. The sclera is closed tightly with 8-0 Vicryl sutures, and the conjunctiva is draped over and secured.
| Field | Code | Rationale |
|---|---|---|
| CPT 1 | 65280-79-RT | Repair of perforating scleral laceration. Modifier -79 is appended because this is an unrelated procedure performed during the 90-day global period of the prior cataract surgery. |
| PDx | S05.31XA | Ocular laceration without prolapse, right eye. |
| SDx | W01.0XXA | Fall on same level from slipping, tripping and stumbling, initial encounter. |
Warning
Example 3 — Inpatient: Concurrent Traumatic Cataract and Corneal Laceration Clinical Scenario: A 40-year-old construction worker suffered a nail gun injury to the right eye. The nail penetrated the cornea and ruptured the anterior capsule of the lens, causing a traumatic cataract, before falling out. In the OR, the surgeon first removes the traumatized lens material using phacoemulsification and places a posterior chamber intraocular lens. The surgeon then meticulously closes the 3 mm corneal laceration with 10-0 nylon sutures.
| Field | Code | Rationale |
|---|---|---|
| CPT 1 | 66984-RT | Extracapsular cataract removal with IOL insertion (Primary, higher-valued procedure). |
| CPT 2 | 65280-51-RT | Repair of perforating corneal laceration. Modifier -51 denotes a multiple procedure. |
| PDx | S05.31XA | Ocular laceration without prolapse, right eye. |
| SDx | H26.111 | Traumatic cataract, right eye. |
Note
Global period reminder: Both procedures carry a 90-day global period. Postoperative visits will be bundled under the global package for the next 90 days.
⚠️ Common Coding Pitfalls
- Missing documentation of uveal involvement: If the operative note fails to mention that the iris or uvea was untouched, but clearly states an open globe, you must default to the lower code (65280). Conversely, if the surgeon describes repositing the iris with a spatula but you bill 65280, you are losing legitimate revenue that belongs under 65285.
- Confusing nonperforating vs. perforating codes: CPT 65275 is for a nonperforating (partial-thickness) corneal laceration and carries a 10-day global period. If you bill 65280 (90-day global) for a superficial scratch or partial-thickness flap that didn’t enter the anterior chamber, it is a severe compliance violation and overpayment.
- Billing separately for conjunctival repair: Scleral lacerations nearly always require cutting and repairing the overlying conjunctiva. CPT 65270 (conjunctival repair) is bundled into 65280 and cannot be reported separately for the same eye.
- Reporting E/M modifiers incorrectly: Applying an eyelid modifier (-E1--E4) to a globe procedure. [[65280]] applies to the eyeball (cornea/sclera), so you must use -RT or -LT, never an E-modifier.
- Failing to track the 90-day global window: Because 65280 is often an emergency procedure, front-desk staff may fail to flag the patient as being in a major global period. Subsequent routine visits for healing checks over the next 3 months will be denied if billed as separate E/M visits.
📎 Sources
AMA CPT 2025 Professional Edition · CMS 2025 Medicare Physician Fee Schedule Final Rule (CMS-1807-F) · CMS RVU25A Relative Value Files · NCCI Policy Manual Chapter VIII, CMS 2024-2025 · ICD-10-CM Official Guidelines for Coding and Reporting FY2025 · ICD-10-PCS Official Guidelines for Coding and Reporting FY2025 · American Academy of Ophthalmology (AAO) Coding Guidelines - Open Globe Trauma