65290

👁️ CPT 65290 — Repair of Wound, Extraocular Muscle, Tendon and/or Tenon’s Capsule

Quick Reference

wRVU: 7.28 | Global Period: 090 (90 days) | Assistant Payable: ✅ Yes | Bilateral Indicator: 1

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📋 Clinical Description

CPT 65290 describes the surgical repair of traumatic injuries to the supportive and motor structures of the eye. This involves suturing a lacerated extraocular muscle (EOM), reattaching a torn tendon to the sclera, or repairing a significant rent in the Tenon’s capsule (the thin membrane enveloping the eyeball). This code is distinct from elective strabismus surgery codes (e.g., 67311) because [[65290]] is strictly for the repair of an acute traumatic wound rather than the planned repositioning of muscles to correct a pre-existing deviation. Extraocular Muscle Laceration is a traumatic injury where one or more of the six muscles responsible for eye movement are cut or detached. If untreated, this results in permanent double vision (diplopia), restricted eye movement, and potential globe instability.

This procedure may be performed in the following clinical contexts:

• Sharp Force Trauma — Closure of muscle lacerations from glass, knives, or projectiles.
• Blunt Force Rupture — Repair of a muscle that has snapped or detached due to high-impact orbital trauma.
• Complex Orbital Lacerations — Repair of the Tenon’s capsule to prevent orbital fat prolapse or scarring between the globe and orbital walls.
• Post-traumatic Muscle Entrapment — Exploratory repair of a muscle damaged during an orbital floor fracture where the muscle itself requires suturing.
• Iatrogenic Injury — Accidental detachment or laceration of a muscle during a different ocular or orbital surgery.

🔬 Anatomical & Procedural Considerations

Modality/Approach Variant	Mechanism or Steps	Key Clinical or Coding Notes
Muscle Suturing	Approximation of severed muscle ends using absorbable sutures (e.g., 6-0 Vicryl).	Requires careful identification of the retracted muscle “stump” within the orbit.
Tendon Reattachment	Securing a detached tendon back to its original insertion point on the sclera.	Documentation must specify that the reattachment was for trauma, not strabismus correction.
Tenon’s Repair	Closing defects in the Tenon’s capsule to maintain the barrier between the globe and orbital fat.	Often performed alongside scleral or conjunctival repairs; usually bundled if secondary.

Clinical Pearl

The defining differentiator for 65290 is the traumatic nature of the service. If the surgeon is performing an “exploration” of a traumatic wound and finds a muscle laceration, 65290 is appropriate. However, if the surgeon is performing the procedure to correct a chronic deviation caused by a previous injury, strabismus codes from the 67311-67318 series may be more accurate depending on the technique used.

✅ Procedure Includes

• Pre-procedure exploration of the wound
• Local, regional, or general anesthesia
• Identification and retrieval of retracted muscle or tendon ends
• Suturing of the muscle, tendon, or capsule
• Irrigation of the wound and conjunctival closure (bundled)
• Application of antibiotic/steroid medication
• Documentation of the integrity of muscle action (forced-duction test)

❌ Excludes / Do Not Report Together

Code	Description	Relationship to 65290
67311	Strabismus surgery, recession or resection; 1 horizontal muscle	Mutually exclusive; for elective correction of ocular alignment.
65270	Repair of conjunctival laceration	Bundled; conjunctival closure is part of the EOM repair.
65280	Repair of corneal/scleral laceration	Separately reportable only if the globe laceration is distinct from the muscle injury.
E/M codes (992xx / 920xx)	Office/ED visit	Separately reportable only with modifier -25 or -57 if the decision for surgery was made during the visit.

Bundling Alert — Global Period is 090, Not 000

CPT 65290 is a major surgical procedure with a 90-day global period. All routine follow-up care is included in the surgical package. Use modifier -24 for unrelated E/M visits or -78 for complications requiring a return to the OR.

🌳 Code Tree — Surgery: Eye and Ocular Adnexa

CPT 65091-68899  Surgery: Eye and Ocular Adnexa
│
├── 65270-65290  Repair of Laceration
│   ├── 65270  Repair of conjunctiva; direct closure
│   ├── 65280  Repair of cornea/sclera, perforating, NOT involving uvea  (Global: 090)
│   ├── 65285  Repair of cornea/sclera, perforating, WITH uveal reposition/resection (Global: 090)
│   └── ▶▶ 65290 ◀◀  Repair of wound, extraocular muscle, tendon and/or Tenon's capsule ← YOU ARE HERE  (Global: 090)

💰 RVU & Reimbursement Profile

Component	Value
Work RVU (wRVU)	7.28
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	General or Monitored Anesthesia Care (MAC)

Bilateral Billing Rules

CPT 65290 has a bilateral indicator of 1. If muscles in both eyes are repaired in the same session, report on a single line with modifier -50 or two lines with -RT and -LT.

🏷️ Modifier Reference

Modifier	Name	When to Apply
-RT	Right Side	Procedure performed on the right eye structures.
-LT	Left Side	Procedure performed on the left eye structures.
-50	Bilateral	Repair performed on both eyes in the same session.
-57	Decision for Surgery	Applied to the E/M code identifying the need for this 90-day global surgery.
-51	Multiple Procedures	When performed alongside other distinct ocular surgeries (e.g., 65280).
-78	Unplanned Return to OR	For postoperative complications (e.g., suture dehiscence).

🩺 Common ICD-10-CM Pairings

Laceration of Extraocular Muscle

ICD-10 Code	Description	HCC?	Clinical Notes
S05.41XA	Laceration of eye muscle, right eye, initial encounter	❌ No	Matches clinical intent for 65290.
S05.42XA	Laceration of eye muscle, left eye, initial encounter	❌ No	Matches clinical intent for 65290.

Other Injuries of Eye and Orbit

ICD-10 Code	Description	HCC?	Clinical Notes
S05.8X1A	Other injuries of right eye and orbit, initial	❌ No	Use for injuries to the Tenon’s capsule or tendons.
S05.11XA	Contusion of eyeball and orbital tissues, right eye, initial	❌ No	Use for traumatic muscle detachments without open laceration.

Coding Specificity Reminder

The “A” 7th character is mandatory for the initial surgical repair. If the patient is seen for a follow-up visit after the surgery, the ICD-10 code should transition to “D” for subsequent encounter, although the E/M would be bundled if within the 90-day global.

🏥 MS-DRG Considerations (Inpatient)

Inpatient Coding Reminder CPT 65290 is primarily outpatient. However, if the injury is part of a major facial or cranial trauma requiring admission, it maps to MDC 02 and DRG 116/117.

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

Note

Facility coding focuses on “Repair” of the specific extraocular muscle.

PCS Code	Full Description	Applicable Modality
08QM0ZZ	Repair Right Extraocular Muscle, Open Approach	Mechanical suturing of muscle.
08QN0ZZ	Repair Left Extraocular Muscle, Open Approach	Mechanical suturing of muscle.
08QL0ZZ	Repair Right Eye, Extraocular Tendon, Open Approach	Repair of tendon detachment.

PCS Character Analysis — 08QM0ZZ

1. Section: 0 (Medical and Surgical)
2. Body System: 8 (Eye)
3. Root Operation: Q (Repair - restoring to normal structure)
4. Body Part: M (Extraocular Muscle, Right)
5. Approach: 0 (Open)
6. Device: Z (No Device)
7. Qualifier: Z (No Qualifier)

📝 Coding Examples

Example 1 — Outpatient Hospital: Trauma Muscle Repair

Clinical Scenario: A 19-year-old male presents with a deep orbital laceration from a fishing hook. The surgeon explores the wound and finds the medial rectus muscle is partially severed. The surgeon approximates the ends and sutures the muscle with 6-0 Vicryl.

Field	Code	Rationale
CPT	65290-RT	Repair of extraocular muscle wound.
PDx	S05.41XA	Laceration of eye muscle, right.

Example 2 — ASC: Tenon’s Capsule Repair

Clinical Scenario: During an orbital exploration for a suspected foreign body, the surgeon identifies a large traumatic tear in the Tenon’s capsule allowing orbital fat to prolapse. The surgeon reduces the fat and sutures the capsule.

Field	Code	Rationale
CPT	65290-LT	Repair of Tenon’s capsule.
PDx	S05.8X2A	Other injuries of left eye and orbit.

⚠️ Common Coding Pitfalls

• Billing elective Strabismus codes: Do not bill 67311 for an emergency trauma repair. 65290 has a significantly different wRVU and global period.
• Unbundling conjunctival repair: Do not bill 65270 separately; the access to the muscle is through the conjunctiva, making the repair of that access point inherent to the procedure.
• Decision for Surgery Modifier: Since 65290 is a 90-day major surgery, use -57 on the E/M where the decision to operate was made, not -25.
• Missing laterality: Payers will frequently deny EOM repairs without -RT or -LT modifiers.

📎 Sources

AMA CPT 2025 Professional Edition · CMS 2025 Medicare Physician Fee Schedule · NCCI Policy Manual Chapter VIII · ICD-10-CM Official Guidelines FY2025 · AAO EyeNet Coding: “Trauma and Repairs” (2024).