65285

👁️ CPT 65285 — Repair of Laceration; Cornea and/or Sclera, Perforating, With Reposition or Resection OF Uveal Tissue

Quick Reference

wRVU: 14.93 | Global Period: 090 (90 days) | Assistant Payable: ✅ Yes | Bilateral Indicator: 1

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📋 Clinical Description

CPT 65285 describes the high-complexity primary closure of an open-globe injury where the cornea or sclera has been fully penetrated, and intraocular “uveal” tissue (the iris, ciliary body, or choroid) has herniated through the wound. The surgeon must either carefully reposition the prolapsed uvea back into the anterior or posterior chamber or, if the tissue is necrotic or heavily contaminated, resect (excise) the damaged portions before suturing the cornea or sclera watertight. This code is explicitly distinguished from its sibling code 65280 by the documentation of uveal manipulation; 65280 is assigned when the uvea is completely uninvolved or remains safely behind the laceration.

Iris Prolapse is a sight-threatening emergency where the pigmented iris tissue is forced through a perforating wound by the eye’s internal pressure. If untreated, this leads to permanent pupil distortion, secondary glaucoma, endophthalmitis, or sympathetic ophthalmia (a rare autoimmune attack on the uninjured eye). While simple lacerations may be self-sealing, uveal incarceration requires surgical intervention to prevent the iris from acting as a “wick” for bacteria to enter the eye.

This procedure may be performed in the following clinical contexts:

• Penetrating trauma with iris prolapse — Use when a sharp object causes a corneal wound through which the iris has herniated.
• Scleral rupture with ciliary body involvement — Closure of a posterior rupture where the ciliary body or choroid is visible or incarcerated in the wound.
• Iatrogenic wound dehiscence with uveal incarceration — Repair of a surgical incision (e.g., post-cataract) that has ruptured and trapped iris tissue.
• Perforating injury from high-velocity projectile — Extraction of an object and repair of the entry site involving uveal resection.
• Severe ocular rupture with choroidal exposure — Primary closure of a large globe rupture following severe blunt force trauma.

🔬 Anatomical & Procedural Considerations

Modality/Approach Variant	Mechanism or Steps	Key Clinical or Coding Notes
Uveal Repositioning	Using a cyclodialysis spatula or viscoelastics to gently push incarcerated iris back into the anterior chamber.	Documentation must show the uvea was manipulated or replaced to support 65285.
Uveal Resection (Abscission)	Cutting away necrotic or contaminated iris/uveal tissue that cannot be safely returned to the eye.	This is an inherent part of 65285; do not report a separate iridectomy code.
Watertight Suturing	Closure of the cornea/sclera with 10-0 nylon or 8-0 Vicryl sutures under an operating microscope.	Operating microscope use is bundled; reformation of the AC is also bundled.

Clinical Pearl

The defining characteristic for CPT 65285 is the “uveal tissue” management. If the operative report describes a “prolapsed iris” that was “repositioned with a spatula,” or “necrotic iris tissue was excised,” the coder should choose 65285. If the note simply says “the wound was sutured,” but the iris was noted to be in a “normal position” and “not involved,” the code must be downcoded to 65280.

✅ Procedure Includes

• Pre-procedure exploration of the globe under anesthesia
• General or local anesthesia with retrobulbar block
• Repositioning or resection of prolapsed uveal tissue
• Suturing of the corneal and/or scleral laceration
• Reformation of the anterior chamber with air, BSS, or viscoelastics
• Application of subconjunctival antibiotics and steroids
• Documentation of wound integrity (Seidel test)

❌ Excludes / Do Not Report Together

Code	Description	Relationship to 65285
65280	Repair of laceration; cornea/sclera, perforating, without uveal involvement	Mutually exclusive; 65285 is the higher-level code for uveal involvement.
66600	Iridectomy, with corneal or scleral section	Bundled; resection of the iris is part of the laceration repair in 65285.
66020	Injection, anterior chamber of eye	Bundled; reformation of the chamber is a standard part of the repair.
65270	Repair of conjunctival laceration	Bundled; conjunctival closure is included in the scleral repair.
E/M codes (992xx / 920xx)	Office/ED visit	Separately reportable only with modifier -25 or -57 if the decision for surgery was made during that visit.

Bundling Alert — Global Period is 090, Not 010

CPT 65285 is a major surgical procedure. The 90-day global period means all routine follow-up care is bundled. If the patient returns for an unrelated issue (e.g., a scratch on the other eye), use modifier -24. If a complication requires an unplanned return to the OR (e.g., wound leak or endophthalmitis), use modifier -78.

🌳 Code Tree — Surgery: Eye and Ocular Adnexa

CPT 65091-68899  Surgery: Eye and Ocular Adnexa
│
├── 65270-65286  Repair of Laceration
│   ├── 65270  Repair of conjunctiva; direct closure
│   ├── 65275  Repair of cornea, nonperforating  (Global: 010)
│   ├── 65280  Repair of cornea/sclera, perforating, NOT involving uvea  (Global: 090)
│   ├── ▶▶ 65285 ◀◀  Repair of cornea/sclera, perforating, WITH uveal reposition/resection ← YOU ARE HERE  (Global: 090)
│   └── 65286  Application of tissue glue, cornea/sclera  (Global: 010)

💰 RVU & Reimbursement Profile

Component	Value
Work RVU (wRVU)	14.93
Global Period	090
Bilateral Indicator	1
Assistant Surgeon	✅ Payable
Co-Surgeon	❌ Not Applicable
Team Surgery	❌ Not Applicable
PC/TC Split	0 - Procedure Code Only
Modifier -51 Exempt	No
Anesthesia	Standard Eye Anesthesia (00140)

Bilateral Billing Rules

CPT 65285 has a bilateral indicator of 1. If both eyes are repaired in the same session, report one line with modifier -50 or two lines with -RT and -LT. Payment is typically adjusted to 150% of the single procedure allowable.

🏷️ 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	Both eyes repaired in the same session.
-57	Decision for Surgery	Applied to the E/M code when the surgeon determines the patient needs this major (90-day) surgery during an initial exam.
-51	Multiple Procedures	When performed with another surgery (e.g., vitreous aspiration) in the same session.
-78	Unplanned Return to OR	For complications like a postoperative wound leak within the 90-day window.
-79	Unrelated Procedure	If this repair occurs during the global window of a previous, unrelated surgery.

🩺 Common ICD-10-CM Pairings

Ocular Laceration with Prolapse

ICD-10 Code	Description	HCC?	Clinical Notes
S05.21XA	Ocular laceration with prolapse, right eye, initial	❌ No	Matches clinical intent of 65285.
S05.22XA	Ocular laceration with prolapse, left eye, initial	❌ No	Matches clinical intent of 65285.

Penetrating Wound with Foreign Body

ICD-10 Code	Description	HCC?	Clinical Notes
S05.51XA	Penetrating wound with FB, right eye	❌ No	Use if a foreign body is present in the eye.
S05.52XA	Penetrating wound with FB, left eye	❌ No	Penetrating wound with FB, left eye.

Coding Specificity Reminder

The primary axis of specificity for 65285 pairings is the 7th character “A” for initial encounter. Most open-globe injuries are coded as initial encounters even if transferred from an ER, as long as the surgeon is providing active treatment. ICD-10-CM specificity requirements are not optional.

🏥 MS-DRG Considerations (Inpatient)

Inpatient Coding Reminder CPT 65285 is frequently performed as an outpatient or ASC procedure, but severe trauma often requires inpatient admission for IV antibiotics. When this drives an admission, it maps to MDC 02 and DRG 116 (Intraocular Procedures with CC/MCC) or DRG 117 (Intraocular Procedures without CC/MCC).

🔧 ICD-10-PCS Equivalents (Inpatient Facility Coding)

Note Facility coding focuses on “Repositioning” or “Excision” of the specific eye structures. If the iris is repositioned, use the Reposition root operation.

PCS Code	Full Description	Applicable Modality
08S80ZZ	Reposition Right Cornea, Open Approach	General closure of cornea.
08S90ZZ	Reposition Left Cornea, Open Approach	General closure of cornea.
08S00ZZ	Reposition Right Iris, Open Approach	Specific iris repositioning (maps to 65285).
08B00ZZ	Excision of Right Iris, Open Approach	Specific iris resection (maps to 65285).

PCS Character Analysis — 08S00ZZ

1. Section: 0 (Medical and Surgical)
2. Body System: 8 (Eye)
3. Root Operation: S (Reposition - moving a body part to its normal location)
4. Body Part: 0 (Iris, Right)
5. Approach: 0 (Open)
6. Device: Z (No Device)
7. Qualifier: Z (No Qualifier)

📝 Coding Examples

Example 1 — Outpatient Hospital: Trauma with Iris Prolapse

Clinical Scenario: A 35-year-old female presents after a sharp object struck her right eye. Exam shows a 5mm corneal laceration with iris tissue protruding through the wound (iris prolapse). In the OR, the surgeon uses a spatula to reposition the iris tissue back into the anterior chamber. The cornea is then sutured with 10-0 nylon.

Field	Code	Rationale
CPT	65285-RT	Perforating repair with uveal repositioning.
PDx	S05.21XA	Ocular laceration with prolapse, right eye.

Example 2 — Inpatient: Scleral Rupture and Resection

Clinical Scenario: A 50-year-old male suffered a blunt force injury. Scleral rupture is noted. Necrotic ciliary body tissue is seen in the wound and is resected. The sclera is then sutured.

Field	Code	Rationale
CPT	65285-RT	Perforating repair with uveal resection.
PDx	S05.21XA	Ocular laceration with prolapse, right eye.

⚠️ Common Coding Pitfalls

• Downcoding to 65280: The most common error is choosing 65280 when the uvea was actually manipulated. Always look for keywords like “spatula,” “viscoelastic repositioning,” or “resection.”
• Missing Modifier -57: Since this is a 90-day global procedure, an E/M on the day of or day before surgery that resulted in the decision to operate must have -57, not -25.
• Failing to query for uveal tissue: If the physician dictates “repaired corneal laceration” but mentions the iris was in the wound in the H&P, query to see if 65285 is supported.
• Reporting iridectomy separately: Resection of the iris is included in 65285. Reporting 66600 separately is unbundling.

📎 Sources

AMA CPT 2025 Professional Edition · CMS 2025 Medicare Physician Fee Schedule · NCCI Policy Manual Chapter VIII · ICD-10-CM Official Guidelines FY2025 · AAPC Ophthalmology Coding Alert (2024) · Ophthalmology Management — “Coding & Reimbursement: Trauma” (Jan 2024) · Palmetto GBA Jurisdiction M Policy.