65800

🩺 CPT 65800 — Paracentesis of Anterior Chamber of Eye (Separate Procedure); With Removal of Aqueous

Code Overview

CPT 65800 describes paracentesis of the anterior chamber of the eye with removal of aqueous humor. It is classified as a “separate procedure” — a CPT designation indicating that while it is a distinct, definable service, it may be considered a component of a more comprehensive procedure when performed concurrently. The parenthetical “(separate procedure)” designation does not mean the code is never separately billable — it is fully separately reimbursable when performed as a standalone procedure or when combined with certain other procedures that do not subsume it under NCCI policy.

CPT 65800 carries a zero (000) global period, meaning every encounter at which it is performed is independently billable with no pre-operative or post-operative services included. It is primarily performed in three major clinical contexts: emergency IOP reduction (acute angle-closure glaucoma, severe ocular hypertension), acute central retinal artery occlusion (CRAO) treatment (to reduce IOP and increase retinal perfusion pressure), and diagnostic aqueous sampling (suspected endophthalmitis, infectious keratitis, uveitis workup). The code has a nuanced NCCI bundling landscape that is essential for accurate ophthalmology billing.

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Full Code Description

Element	Detail
CPT Code	65800
Full Descriptor	Paracentesis of anterior chamber of eye (separate procedure); with removal of aqueous
Section	Incision Procedures on the Anterior Chamber (65800-65880)
System	Eye and Ocular Adnexa
Global Period	000 — Zero days (no pre- or post-operative period)
Separate Procedure	Yes — “(separate procedure)” is in the code descriptor
wRVU	~1.74
Facility Total RVU	~2.30
Non-Facility Total RVU	~3.42
Assistant Surgeon	Not allowed
Bilateral	Not applicable as written — use -RT/-LT modifiers; -50 if bilateral
Add-On Code	No
Modifier 51 Exempt	No
Telehealth	No
Anesthesia Code	00145 — Anesthesia for procedures on the eye; not otherwise specified

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Clinical Description

Anatomy of the Anterior Chamber

The anterior chamber is the fluid-filled space at the front of the eye, bounded by:

• Anteriorly: Posterior surface of the cornea (corneal endothelium)

• Posteriorly: Anterior surface of the iris and, centrally, the anterior surface of the crystalline lens (or IOL in pseudophakic patients)

• Peripherally: The anterior chamber angle, formed by the trabecular meshwork, Schwalbe’s line, Schlemm’s canal, and the iris root

The anterior chamber contains aqueous humor — a clear, plasma-derived fluid produced by the ciliary body epithelium via active secretion and ultrafiltration. Aqueous humor:

• Fills the anterior chamber and the posterior chamber (the space behind the iris, anterior to the lens)

• Flows from the posterior chamber through the pupil into the anterior chamber

• Drains primarily through the trabecular meshwork → Schlemm’s canal → collector channels → episcleral venous system (conventional/pressure-dependent outflow, ~80%)

• Also drains via the uveoscleral (unconventional) pathway through the ciliary body and choroidal vessels (~20%)

• Maintains intraocular pressure (IOP) through the balance of production and outflow

• Provides nutrition to avascular anterior segment structures (corneal endothelium, lens)

• Normal volume: approximately 200-300 microliters (0.2-0.3 mL) — making paracentesis removal of even 0.1-0.2 mL a clinically significant IOP reduction

The anterior chamber angle is the critical drainage structure. Obstruction of the angle (pupillary block, angle closure, trabecular dysfunction) causes aqueous accumulation and IOP elevation — the foundation for the most common emergent indication for CPT 65800.

What CPT 65800 Describes

Paracentesis of the anterior chamber with removal of aqueous is the introduction of a fine-gauge needle or cannula through the peripheral cornea (at or near the limbus) into the anterior chamber, with removal of a small volume (0.1-0.3 mL) of aqueous humor. The aqueous removal:

• Immediately reduces IOP by decreasing the volume of fluid within the eye — lowering pressure proportional to the volume removed

• Provides aqueous fluid for diagnostic laboratory analysis when sampling is the indication

• Creates a pressure differential that transiently increases perfusion pressure to the optic nerve head and retina — the mechanism of benefit in CRAO

The removed volume of aqueous is small but physiologically significant — a 0.1-0.2 mL tap in an eye with a volume of approximately 200 mL can reduce IOP by 20-40+ mmHg acutely.

Aqueous Humor Dynamics and IOP Physiology

IOP is governed by the Goldmann equation:

IOP=FC+PvIOP = \frac{F}{C} + P_vIOP=CF+Pv

Where:

• FFF = Rate of aqueous production (normal: ~2-2.5 μL/min)

• CCC = Facility of aqueous outflow (trabecular meshwork conductance)

• PvP_vPv = Episcleral venous pressure (normal: 8-10 mmHg)

Paracentesis (CPT 65800) acutely reduces IOP by physically removing aqueous volume, transiently bypassing the entire outflow system. The IOP reduction is immediate but temporary — IOP will gradually return toward baseline as the ciliary body continues to produce aqueous and the eye’s volume is restored.

Normal IOP: 10-21 mmHg. In acute angle-closure crisis, IOP may reach 50-70+ mmHg. In CRAO, even modest IOP reduction (lowering from 15 mmHg to 5-8 mmHg) may meaningfully increase retinal perfusion pressure enough to dislodge an embolus or restore perfusion.

Clinical Indications for CPT 65800

Indication 1 — Acute Central Retinal Artery Occlusion (CRAO)

This is one of the most critical and time-sensitive indications for CPT 65800. CRAO is an ophthalmic emergency — the retinal equivalent of a stroke — caused by obstruction of the central retinal artery by thromboembolism, resulting in complete or near-complete loss of blood supply to the inner retinal layers.

Pathophysiology of ischemic injury:

• Inner retinal neurons (ganglion cells, inner nuclear layer) can tolerate ischemia for approximately 90-100 minutes before irreversible damage occurs

• The retina has no pain sensation — patients present with sudden, painless, profound unilateral vision loss

• On funduscopy: cherry-red spot at the fovea (the choroidal circulation visible through the thin foveal retina contrasts with the surrounding pale, ischemic inner retina), arteriolar attenuation, cattle-trucking of blood in retinal vessels, retinal pallor/whitening from intracellular edema

Mechanism of benefit of AC paracentesis in CRAO:
Lowering IOP by removing aqueous humor via paracentesis (CPT 65800) reduces the resistance to retinal arterial perfusion:

• The ocular perfusion pressure (OPP) = Mean arterial pressure - IOP

• By acutely lowering IOP, OPP increases

• Increased OPP may be sufficient to dislodge or move an embolus from the arterial lumen, restore partial flow distal to a thrombus, or improve marginal perfusion in collateral vessels

• Additionally, the sudden IOP drop may produce a pressure wave within the vasculature that physically dislodges a soft fibrin-platelet embolus

Time-criticality:
Treatment must occur within the first 2-4 hours of symptom onset for any meaningful chance of visual recovery. Some sources suggest a window of up to 6 hours for the procedure to be beneficial. Beyond approximately 6 hours of complete ischemia, the photoreceptors and ganglion cells are typically irreversibly damaged and paracentesis is unlikely to restore vision — though it may still prevent further progression.

CRAO workup:
CRAO is not simply an eye disease — it is a neurological emergency with stroke implications. In the acute setting, concurrent neurology/stroke team involvement is essential:

• Neuroimaging (MRI brain DWI + MRA) to evaluate for concurrent ischemic stroke (concurrent cerebral ischemia found in ~25% of CRAO patients)

• Carotid ultrasound or CTA of the carotid arteries (identify ipsilateral high-grade stenosis or vulnerable plaque)

• Echocardiography (cardiac embolic source)

• Hematologic workup (hypercoagulable state, hyperviscosity syndromes)

Indication 2 — Acute Angle-Closure Glaucoma (AACG) — Emergency IOP Reduction

Acute angle-closure glaucoma (H40.211-H40.212 depending on laterality) presents with sudden, severe IOP elevation (often 40-70+ mmHg) due to closure of the anterior chamber angle from pupillary block (iris apposes the lens, blocking aqueous flow from the posterior to anterior chamber, creating a pressure gradient that bows the iris peripherally — “iris bombé” — closing the angle).

Classic presentation: sudden onset of severe periocular pain, blurred vision, rainbow halos around lights, nausea/vomiting (vagal response to pain), fixed mid-dilated pupil, corneal edema, conjunctival injection.

Role of CPT 65800 in AACG:

• When pharmacologic measures (topical beta-blockers, alpha-2 agonists, carbonic anhydrase inhibitors, pilocarpine, systemic acetazolamide, IV mannitol) fail to adequately lower IOP

• As an urgent/emergent bridge to definitive treatment (laser peripheral iridotomy — CPT 66761, or surgical peripheral iridectomy — CPT 66625) to protect the optic nerve from severe acute IOP-related damage

• Reduces IOP acutely and may help clear the corneal edema enough to allow laser iridotomy (LPI) to be performed

• Some glaucoma specialists perform AC paracentesis before LPI when the corneal edema prevents adequate laser energy transmission

Indication 3 — Diagnostic Aqueous Sampling

AC paracentesis for aqueous humor collection is performed when laboratory analysis of intraocular fluid is needed for diagnosis. Clinical contexts:

Infectious endophthalmitis (suspected):

• When endophthalmitis is suspected (acute-onset vision loss, hypopyon, severe anterior chamber reaction, pain) and vitreous biopsy (CPT 67015) is also performed, AC tap collects aqueous for:

  • Culture and sensitivity (bacterial, fungal, viral)

  • PCR for specific organisms (HSV, CMV, VZV, Toxoplasma)

  • Stains (Gram stain, KOH for fungal)

• The aqueous sample is smaller than the vitreous sample and has lower diagnostic sensitivity for endophthalmitis, but combined sampling increases yield

Infectious keratitis workup:

• When the causative organism of a severe corneal ulcer cannot be identified by corneal scraping alone, aqueous sampling for PCR or culture may provide additional diagnostic information

Anterior uveitis workup:

• When viral uveitis is suspected (CMV anterior uveitis, HSV/VZV uveitis, herpes simplex trabeculitis), aqueous PCR testing for herpesvirus DNA confirms the etiology and directs antiviral therapy

• CMV anterior uveitis with Posner-Schlossman syndrome (recurrent hypertensive uveitis) — aqueous CMV PCR is the diagnostic standard

Masquerade syndromes:

• When intraocular lymphoma is suspected in the setting of anterior chamber cells and atypical uveitis that doesn’t respond to steroids, aqueous cytology and flow cytometry may reveal malignant lymphocytes

Pharmacokinetic studies:

• Research protocols measuring intraocular drug levels (e.g., post-intravitreal anti-VEGF injection aqueous sampling to quantify drug penetration) — not routinely a clinical billing indication

Indication 4 — Severe Ocular Hypertension Unresponsive to Maximal Medical Therapy

In patients with markedly elevated IOP (typically > 40-50 mmHg) from any cause — severe open-angle glaucoma, uveitic glaucoma, neovascular glaucoma, hyphema-related IOP elevation — when maximum topical and systemic medical therapy has failed to reduce IOP to safe levels within an acceptable timeframe, AC paracentesis provides immediate IOP reduction to protect the optic nerve while more definitive interventional therapy (trabeculoplasty, filtering surgery, tube shunt) is arranged.

Indication 5 — Pharmacologic Agent Injection (When Separate From 65800)

Note: AC paracentesis performed as a preparatory step before injecting medication into the anterior chamber (e.g., intracameral antibiotic at end of cataract surgery — such as intracameral moxifloxacin or cefuroxime) is typically included in the primary procedure (e.g., 66984 cataract extraction) and not separately coded with 65800. However, when a standalone AC injection procedure is performed as a separate encounter service, CPT 66030 (injection, anterior chamber, medication) may be appropriate.

Procedure Description

Equipment:

• Topical anesthetic (proparacaine 0.5%, tetracaine)

• Povidone-iodine 5% antiseptic solution

• Sterile drape and speculum (optional for cooperative patients; typically used in OR setting)

• 27-30 gauge needle on a 1 mL syringe (tuberculin syringe)

• Slit lamp for office-based procedures (preferred — provides direct visualization, magnification, and illumination)

• OR microscope for OR-based procedures

• Sterile collection container if aqueous is being sent for diagnostic analysis

Technique (slit-lamp-based approach — most common):

1. Topical anesthesia: Instill two to three drops of proparacaine. Some providers add a pledget of topical anesthetic held against the limbus at the anticipated entry site for additional local anesthesia.

2. Antisepsis: Instill one drop of 5% povidone-iodine into the conjunctival sac and allow to sit for 30-60 seconds. This step is essential to reduce infection risk for any intraocular procedure.

3. Speculum placement (optional): A wire speculum provides exposure and prevents the patient from inadvertently closing the eye during the procedure.

4. Entry site selection: The needle is introduced through the peripheral cornea at the limbus (corneal paracentesis approach) or occasionally through the cornea 1-1.5 mm central to the limbus. Entry through the cornea (rather than the sclera) avoids conjunctival vessels and allows direct visualization under the slit lamp. The entry is made at the temporal limbus (3 o’clock in the right eye, 9 o’clock in the left eye) in most right-handed providers.

5. Needle entry: A 27-30 gauge needle is advanced through the corneal stroma in a tunnel fashion — entering parallel to the iris plane to avoid lens touch (in phakic patients), directed toward the central anterior chamber. Proper tunnel construction creates a self-sealing wound — the oblique track prevents aqueous egress after needle removal.

6. Aspiration: The syringe plunger is gently withdrawn to aspirate 0.1-0.2 mL of aqueous humor. The aqueous is clear in normal eyes; cloudy, flocculent, fibrinous, or hemorrhagic aqueous indicates pathology. In diagnostic samples, the full aspirated volume is collected into a sterile tube for laboratory submission.

7. Needle removal: The needle is withdrawn in a controlled motion maintaining the tunnel direction to preserve wound integrity.

8. Wound assessment: The self-sealing tunnel wound is assessed for leakage. A Seidel test (instillation of fluorescein and examination under cobalt blue light) can confirm wound integrity if needed. A well-constructed tunnel wound will be self-sealing in virtually all cases.

9. IOP assessment: IOP is measured immediately after the procedure (Goldmann tonometry or Tono-Pen) to document the degree of IOP reduction achieved.

10. Post-procedure medications: Topical antibiotic drop (e.g., ciprofloxacin, moxifloxacin) is instilled to reduce infection risk.

For CRAO — specific technique modifications:

• The aspiration volume may be slightly larger (0.2-0.3 mL) to achieve maximum acute IOP reduction

• The procedure is performed under the slit lamp when the patient is ambulatory; for very ill patients (emergency department), a portable slit lamp or operating microscope approach is used

• Immediate funduscopic assessment of the retinal circulation after the procedure documents whether the embolus has moved or retinal blood flow has been restored

OR-based paracentesis:
When performed in the OR (e.g., intraoperative context during cataract surgery — creating a paracentesis incision is a standard component of phacoemulsification — or as a standalone procedure in a patient too ill for slit-lamp cooperation), the technique uses a MVR blade (microvitreoretinal blade) or keratome to create a standard surgical paracentesis wound. Note: the routine paracentesis wound created as part of cataract surgery (66984) is included in the cataract CPT and is NOT separately coded with 65800.

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CPT Code Tree — Paracentesis of Anterior Chamber Family

Eye and Ocular Adnexa — Anterior Segment
  └── Incision Procedures on the Anterior Chamber (65800-65880)
        │
        ├── 65800    Paracentesis of anterior chamber (separate procedure);
        │            with removal of aqueous    ◄ THIS CODE
        │            (Aqueous removal only — for IOP reduction, CRAO, diagnostic AC tap)
        │
        ├── [[65810]]    Paracentesis of anterior chamber (separate procedure);
        │            with removal of vitreous and/or discission of anterior
        │            hyaloid membrane, with or without air injection
        │            (More complex — vitreous in the anterior chamber; anterior vitrectomy aspect)
        │
        ├── [[65815]]    Paracentesis of anterior chamber (separate procedure);
        │            with removal of blood, with or without irrigation
        │            and/or air injection
        │            (Hyphema washout — blood in the AC; includes irrigation)
        │
        ├── [[65820]]    Goniotomy
        │            (Angle surgery — knife enters through clear cornea to incise trabecular meshwork)
        │
        ├── [[65850]]    Trabeculotomy ab externo
        │            (External approach trabecular meshwork incision)
        │
        ├── [[65855]]    Trabeculoplasty by laser surgery (1 or more sessions, same eye)
        │            (SLT, ALT)
        │
        ├── [[65860]]    Severing adhesions of anterior segment; laser technique
        │
        ├── [[65865]]    Severing adhesions of anterior segment; incisional technique
        │            (goniosynechialysis) (separate procedure)
        │
        ├── [[65870]]    Severing adhesions of anterior segment; without injection of air
        │            or liquid (separate procedure); anterior synechiae, except
        │            goniosynechiae
        │
        └── [[65880]]    Severing adhesions of anterior segment; posterior synechiae

Critical Differentiation — 65800 vs 65810 vs 65815

Code	Procedure	Content Removed	Key Indication
65800	Paracentesis + aqueous removal	Aqueous humor only (clear fluid)	CRAO, acute IOP reduction, diagnostic tap, AC hypertension, endophthalmitis sampling
65810	Paracentesis + vitreous removal ± anterior hyaloid discission ± air injection	Vitreous in the anterior chamber	Vitreous prolapse into AC (post-cataract complication, after PPV), anterior hyaloid membrane disruption
65815	Paracentesis + blood removal ± irrigation ± air injection	Blood (hyphema)	Hyphema — blood pooled in the anterior chamber; includes lavage/irrigation and optional air tamponade

These three codes (65800, 65810, 65815) are mutually exclusive per NCCI policy. The CMS NCCI Policy Manual explicitly states that codes 65800-65815 (defined as separate procedures) cannot be reported together when performed on the same eye at the same patient encounter. This means if both aqueous removal and blood removal occur in the same AC paracentesis session, only the more comprehensive code (65815 for hyphema with irrigation) should be reported, not both 65800 and 65815.

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Includes / Excludes Notes

What Is Included in CPT 65800

CPT 65800 includes:

• Initial corneal needle entry (paracentesis wound creation)

• Aspiration/removal of aqueous humor from the anterior chamber

• Basic pressure equalization and wound self-sealing assessment

• Topical anesthetic administration

• Standard immediate post-procedure care (antibiotic drop)

• IOP measurement immediately following the procedure (typically bundled)

What Is NOT Included in CPT 65800 (May Be Separately Reported When Applicable)

• Irrigation of the anterior chamber — if extensive irrigation follows the aqueous tap, 65815 (with irrigation) may be more appropriate than 65800

• Air or fluid injection following the tap — if air or viscoelastic material is injected to reform the anterior chamber after the tap, a higher-level code may apply

• Intravitreal injection (67028) — when concurrently performed, NCCI bundles 65800 with 67028 (see NCCI bundles below)

• Fluorescein angiography, OCT — diagnostic imaging at the same session is separately reportable with appropriate diagnosis linkage

Excludes / NCCI Bundles

CPT Paired With 65800	Bundle Status	Notes
67028 — Intravitreal injection	Bundled (NCCI) — cannot report together on same eye, same session	The anterior chamber tap is considered a component of or subsidiary to the intravitreal injection service when both performed on the same eye
67025 — Vitreous substitute injection (fluid-gas exchange)	NOT bundled — both separately payable	65800 and 67025 are not NCCI bundled; when both are performed (e.g., pneumatic retinopexy encounter with AC tap for IOP management), both may be reported; payment = 100% of higher + 50% of lower per multiple procedure rules
65810 — Paracentesis with vitreous removal	Mutually exclusive — not reported together, same eye, same session	Same procedure family; code the most comprehensive
65815 — Paracentesis with blood removal	Mutually exclusive — not reported together, same eye, same session	Same procedure family; code the most comprehensive
92014 — Comprehensive ophthalmological exam	May be separately reportable with Modifier -25 if significant, separately identifiable E/M performed	Modifier -25 required; document separate clinical work beyond the procedure
66984 — Cataract extraction phacoemulsification	Paracentesis wound is included in cataract surgery	The routine paracentesis as part of cataract surgery is NOT separately coded 65800
67015 — Aspiration vitreous/fluid	Not bundled	Separately reportable when both AC tap and vitreous aspiration performed (e.g., endophthalmitis)

NCCI bundle 65800 + 67028: The CMS NCCI Policy Manual establishes that CPT codes 65800-65815 cannot be reported with CPT 67028 (intravitreal injection) when performed on the same eye at the same encounter. When a provider performs both an intravitreal injection (67028) and an AC tap (65800) on the same eye at the same session — for example, before an anti-VEGF injection in a patient with elevated IOP — only 67028 is reportable. The AC tap in this context is considered a subsidiary component of preparing the eye for safe injection.

Exception — 65800 + 67025: Unlike the 65800/67028 bundle, CPT 65800 and 67025 (vitreous substitute injection — used in pneumatic retinopexy or fluid-gas exchange) are not NCCI bundled and can both be reported when both are independently indicated and performed. This is a critical distinction in retina coding.

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HCC (Hierarchical Condition Category) Mapping

CPT 65800 itself does not directly map to HCC — CPT codes are procedural and do not carry HCC values. HCC mapping applies to the ICD-10-CM diagnosis codes linked to 65800.

Common Paired ICD-10-CM	Description	HCC Mapping
H34.10	Central retinal artery occlusion, unspecified eye	Not directly HCC mapped
H34.11	CRAO, right eye	Not directly HCC mapped
H34.12	CRAO, left eye	Not directly HCC mapped
H40.211	Acute AACG, right eye	Not HCC mapped
H40.212	Acute AACG, left eye	Not HCC mapped
H21.01	Hyphema, right eye	Not HCC mapped
H21.02	Hyphema, left eye	Not HCC mapped
B00.51	Herpesviral iridocyclitis	Not HCC mapped
H44.001	Unspecified purulent endophthalmitis, right eye	Not HCC mapped
H44.002	Unspecified purulent endophthalmitis, left eye	Not HCC mapped
E10.39	Type 1 diabetes with other diabetic eye disease	HCC 18
E11.39	Type 2 diabetes with other diabetic eye disease	HCC 19
I73.9	Peripheral vascular disease, unspecified	HCC 108
I70.9	Generalized and unspecified atherosclerosis	HCC 108

Note

Vascular risk documentation in CRAO: CRAO is fundamentally a vascular/embolic event. When 65800 is performed for CRAO, concurrent documentation and coding of the underlying vascular risk factors (atrial fibrillation — I48.-, diabetes — E10-E11, carotid stenosis — I65.2-, hyperlipidemia — E78.5) is clinically essential and may carry HCC weight for the visit’s risk adjustment. Accurate coding of all concurrent conditions is critical.

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MS-DRG Mapping (Inpatient)

CPT 65800 is overwhelmingly performed in outpatient and office settings (under the slit lamp). Inpatient admission occurs when the underlying condition driving the paracentesis requires hospitalization — particularly CRAO (neurological emergency), severe endophthalmitis (systemic infection), or acute angle-closure glaucoma with concurrent systemic illness.

CC/MCC Impact of Paired Diagnoses

CPT 65800 is the professional service code. As with all professional codes, it does not directly determine DRG assignment — that is governed by the ICD-10-CM/PCS codes on the UB-04. The CC/MCC status of the associated diagnoses, however, affects DRG tier:

ICD-10-CM	Description	CC/MCC Status
H34.11/12	CRAO, right/left	CC
H40.211/212	Acute AACG	CC
H44.001/002	Purulent endophthalmitis	CC
H44.011/012	Panophthalmitis	MCC
H21.01/02	Hyphema	Not CC/MCC

Inpatient DRGs (When Admitted)

MS-DRG	Description	Context
113	Orbital Procedures with CC/MCC	Not primary for 65800
124	Other Disorders of the Eye with MCC or Thrombolytic Agent	CRAO with concurrent TPA use; CRAO admitted for neurological workup
125	Other Disorders of the Eye without MCC	CRAO or AACG admitted without MCC
61	Acute Ischemic Stroke with Use of Thrombolytic Agent with MCC	If CRAO with concurrent cerebrovascular event + TPA

CRAO and the stroke pathway: CRAO is increasingly managed as a stroke equivalent, and some patients are admitted to stroke units. In those admissions, the DRG may be driven by the neurological diagnosis (stroke or TIA equivalent) rather than the eye diagnosis. Code all concurrent diagnoses including the ocular and neurological findings.

Note

MDC: MDC 02 — Diseases and Disorders of the Eye (when primary diagnosis is the ocular condition)

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ICD-10-CM Diagnosis Codes Commonly Paired With CPT 65800

CRAO (Central Retinal Artery Occlusion)

ICD-10-CM	Description
H34.10	Central retinal artery occlusion, unspecified eye
H34.11	Central retinal artery occlusion, right eye
H34.12	Central retinal artery occlusion, left eye
H34.21	Partial retinal artery occlusion, right eye
H34.22	Partial retinal artery occlusion, left eye

Acute Angle-Closure Glaucoma

ICD-10-CM	Description	Notes
H40.2110	Acute angle-closure glaucoma, right eye, stage unspecified	5th character = eye; 6th character = stage (0-4)
H40.2111	Acute angle-closure glaucoma, right eye, mild stage	Stage 1
H40.2113	Acute angle-closure glaucoma, right eye, severe stage	Stage 3
H40.2120	Acute angle-closure glaucoma, left eye, stage unspecified
H40.2130	Acute angle-closure glaucoma, bilateral, stage unspecified

Note

Glaucoma stage coding (6th character): H40.21 requires a 6th character for stage: 0 = unspecified; 1 = mild; 2 = moderate; 3 = severe; 4 = indeterminate. Always document the stage in the provider note to support the most specific code. In an acute crisis, H40.211X0 (stage unspecified) is appropriate when the clinical focus is the acute attack rather than a formal staged assessment.

Endophthalmitis (Diagnostic Aqueous Sampling)

ICD-10-CM	Description
H44.001	Unspecified purulent endophthalmitis, right eye
H44.002	Unspecified purulent endophthalmitis, left eye
H44.011	Panophthalmitis, right eye
H44.012	Panophthalmitis, left eye
H44.121	Parasitic endophthalmitis, unspecified, right eye
H44.122	Parasitic endophthalmitis, unspecified, left eye

Uveitis — Diagnostic Aqueous PCR

ICD-10-CM	Description
H20.011	Primary iridocyclitis, right eye
H20.012	Primary iridocyclitis, left eye
H20.021	Recurrent acute iridocyclitis, right eye
H20.022	Recurrent acute iridocyclitis, left eye
B00.51	Herpesviral iridocyclitis
B02.32	Zoster iridocyclitis
B25.8	Other cytomegaloviral diseases (CMV anterior uveitis)

Hyphema (Note: 65815 is More Appropriate Than 65800 When Blood Removal Is the Primary Goal)

ICD-10-CM	Description
H21.01	Hyphema, right eye
H21.02	Hyphema, left eye
H21.03	Hyphema, bilateral
S05.11XA	Contusion of right eyeball and orbital tissues, initial encounter
S05.12XA	Contusion of left eyeball and orbital tissues, initial encounter

Note

65800 vs 65815 for hyphema: If the primary procedure is aqueous removal to reduce IOP and the hyphema is incidental, 65800 may be appropriate. If the primary purpose is to remove blood from the anterior chamber (hyphema washout), 65815 (paracentesis with blood removal, with or without irrigation and/or air injection) is the correct, more specific code. Always let the documentation and primary clinical intent guide code selection.

Ocular Hypertension

ICD-10-CM	Description
H40.051	Ocular hypertension, right eye
H40.052	Ocular hypertension, left eye
H40.053	Ocular hypertension, bilateral

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Billing and Modifier Guidance

Laterality Modifiers — Mandatory

Modifier	Meaning	Application
-RT	Right eye	Procedure performed on right eye
-LT	Left eye	Procedure performed on left eye
-50	Bilateral procedure	Both eyes treated in same session (rare for AC paracentesis but possible in bilateral acute AACG)

Note

Always apply -RT or -LT to CPT 65800. Failure to include a laterality modifier on eye procedure codes is a leading cause of claim rejection and medical record discrepancy.

Modifier -25 — Significant, Separately Identifiable E/M

When CPT 65800 is performed at the same encounter as an E/M service:

• If a significant, separately identifiable evaluation and management service is performed at the same visit (beyond the clinical assessment immediately related to the paracentesis) — for example, a comprehensive glaucoma evaluation in addition to the emergency paracentesis for AACG — the E/M service may be separately reported with Modifier -25

• The E/M note and the procedure note must be distinct and individually documented

• In straightforward “emergent paracentesis only” encounters, there may not be a separately billable E/M service

Modifier -51 — Multiple Procedures

When 65800 is performed alongside another separately reportable ophthalmic procedure at the same session (e.g., 65800 + 67025 vitreous substitute injection):

• Modifier -51 may be applied to the lower-valued procedure (65800 in this case, since 67025 has higher RVU)

• Payment = 100% of 67025 + 50% of 65800 (Medicare multiple procedure reduction)

• Some payers exempt certain codes from the 50% reduction — verify per payer contract

Modifier -59 / X{EPSU} — Distinct Procedural Service

If NCCI edits attempt to bundle 65800 with another procedure despite a valid medical necessity for reporting both separately:

• Modifier -59 (or the more specific XE, XS, XP, XU modifiers) establishes the distinctness of the service

• Document the separate clinical indication, timing, or approach clearly in the procedure note

Modifier -78 — Unplanned Return to OR Within Global Period

CPT 65800 has a zero global period — this modifier applies when the original procedure that created the global period is a different code. For example, if the patient is within the 90-day global period of CPT 67108 (retinal detachment repair) and requires AC paracentesis for a post-operative IOP spike, Modifier -78 on 65800 permits separate billing.

Modifier -79 — Unrelated Procedure During Post-Op Period

If 65800 is performed during the global period of an unrelated procedure (e.g., prior hip surgery global period), Modifier -79 establishes the AC paracentesis as unrelated to the prior surgical service.

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Coding Examples

Example 1 — CRAO, Emergency AC Paracentesis, Office Setting

Clinical Scenario:
A 68-year-old male presents to the ophthalmology office with 2 hours of sudden, painless, complete vision loss in his right eye. Visual acuity is hand motion OD. Fundus exam reveals a cherry-red spot at the fovea, arteriolar attenuation, and diffuse inner retinal whitening consistent with CRAO OD. IOP is 16 mmHg OD. The retina specialist performs emergent AC paracentesis OD under the slit lamp, removing 0.2 mL of aqueous. IOP post-procedure is 5 mmHg. The fundus is re-examined — pulsatile arterial flow is noted in the superior arteriole. The patient is immediately referred to the emergency department for stroke workup.

ICD-10-CM:

• H34.11 — Central retinal artery occlusion, right eye (primary diagnosis — reason for paracentesis)

• I10 — Essential hypertension (additional — vascular risk factor; document all concurrent vascular conditions)

CPT:

• 65800-RT — Paracentesis of anterior chamber of eye, with removal of aqueous, right eye

• 92014-RT-25 — Comprehensive ophthalmological exam, established patient, with Modifier -25 (if a significant, separately documented eye exam was performed beyond the emergency procedure itself)

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Example 2 — Acute Angle-Closure Glaucoma, Paracentesis Before Laser Iridotomy

Clinical Scenario:
A 62-year-old female presents to the emergency ophthalmology clinic with a 4-hour history of severe left periocular pain, nausea, and blurred vision OS. IOP is 64 mmHg OS. The cornea is microcystic edematous, limiting laser iridotomy. After topical and systemic IOP-lowering medications, IOP is 48 mmHg — still elevated. The glaucoma specialist performs AC paracentesis OS under the slit lamp, removing 0.15 mL of aqueous. IOP drops to 18 mmHg. The cornea clears sufficiently to allow laser peripheral iridotomy (LPI) to be performed in the same session.

ICD-10-CM:

• H40.2120 — Acute angle-closure glaucoma, left eye, stage unspecified (primary; stage unspecified in acute crisis context)

CPT:

• 65800-LT — Paracentesis of anterior chamber, aqueous removal, left eye

• 66761-LT — Iridotomy/iridectomy by laser surgery (LPI; performed at same session; -51 multiple procedures on the lower-valued code; verify NCCI edit between 65800 and 66761)

NCCI note for 65800 + 66761: Verify whether NCCI edits bundle these two codes — if so, Modifier -59 or -51 with documentation of distinct clinical necessity for each procedure supports separate reporting. The AC tap was performed to allow the LPI, which is a distinct, subsequent procedure.

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Example 3 — Diagnostic Aqueous Tap, Suspected CMV Anterior Uveitis

Clinical Scenario:
A 55-year-old male with a history of HIV presents with recurrent unilateral elevated IOP and anterior chamber flare OD over 6 months. The pattern is consistent with Posner-Schlossman syndrome or CMV anterior uveitis. The anterior segment specialist performs AC paracentesis OD under the slit lamp, collecting 0.1 mL of aqueous, which is sent for CMV PCR, HSV PCR, and aqueous ACE level. Results return positive for CMV DNA. Diagnosis: CMV anterior uveitis with hypertensive component. Anti-CMV therapy (oral valganciclovir) is initiated.

ICD-10-CM:

• H20.021 — Recurrent acute iridocyclitis, right eye (primary — the clinical presentation)

• B25.8 — Other cytomegaloviral diseases (additional once CMV is confirmed — links the etiology)

• B20 — Human immunodeficiency virus [HIV] disease (additional — immunocompromised state)

CPT:

• 65800-RT — Paracentesis of anterior chamber of eye, with aqueous removal (diagnostic tap), right eye

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Example 4 — Paracentesis During Global Period of Retinal Surgery, Modifier -78

Clinical Scenario:
A 70-year-old male underwent pars plana vitrectomy OD (CPT 67036) 3 weeks ago. He presents with IOP 58 mmHg OD — steroid-induced ocular hypertension from post-operative steroid drops, unresponsive to topical IOP-lowering agents added. The retina specialist performs AC paracentesis OD in the office to urgently lower IOP and protect the optic nerve.

ICD-10-CM:

• H40.051 — Ocular hypertension, right eye (primary — uncontrolled IOP driving the paracentesis)

• H59.811 — Chorioretinal scars after surgery for detachment, right eye (or appropriate post-PPV status code — additional)

CPT:

• 65800-RT-78 — Paracentesis of anterior chamber, right eye, Modifier -78 (return to OR/procedure room during 90-day global period of CPT 67036 for a related complication — steroid-induced IOP elevation in the post-op eye)

Global period for 67036 is 90 days. The IOP complication is related to the prior vitrectomy and its post-operative steroid management — Modifier -78 is appropriate. Reimbursement is reduced to the intraoperative component only.

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Example 5 — Pneumatic Retinopexy With AC Tap — 65800 + 67025 (Not Bundled)

Clinical Scenario:
A 60-year-old female undergoes pneumatic retinopexy OD (CPT 67110 or 67025 gas injection) for a superior retinal detachment. At the same session, the retina specialist performs AC paracentesis OD to lower IOP before injecting the expansile gas bubble (C3F8), as the gas injection will increase IOP and there is a risk of central retinal artery compromise. The AC tap is performed immediately before the gas injection to create room for the gas and prevent acute IOP spike.

ICD-10-CM:

• H33.001 — Unspecified retinal detachment with retinal break, right eye (primary — reason for the pneumatic retinopexy)

• H34.11 — Central retinal artery occlusion, right eye (if concurrent CRAO risk being mitigated — or omit if not documented as a separate diagnosis)

CPT:

• 67025-RT — Injection of vitreous substitute, pars plana or limbal approach, right eye (primary; higher wRVU; 100% of allowed amount)

• 65800-RT-51 — Paracentesis of anterior chamber, aqueous removal, right eye (additional; -51 multiple procedures; 50% of allowed amount)

65800 + 67025 are NOT bundled. This is one of the most frequently cited coding examples in retina coding. The NCCI does not bundle these two codes — both are separately payable with multiple procedure rules applying. Confirm with each payer as commercial payer policies vary.

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Example 6 — AC Tap With Simultaneous Intravitreal Injection — 65800 Bundled Into 67028

Clinical Scenario:
A 75-year-old female with neovascular AMD OS presents for a routine intravitreal anti-VEGF injection (67028). Her IOP is 24 mmHg OS before the injection. The retina specialist performs a small AC tap immediately before the injection to lower IOP and prevent a post-injection IOP spike to ischemic levels, then performs the intravitreal injection.

ICD-10-CM:

• H35.32 — Exudative age-related macular degeneration, left eye (primary)

• H40.052 — Ocular hypertension, left eye (additional)

CPT:

• 67028-LT — Intravitreal injection, left eye (only code reportable — 65800 is bundled into 67028 per NCCI when both are performed on the same eye at the same session)

• 65800-LT is NOT separately reportable in this scenario

NCCI bundle in action: The AC tap performed as part of preparation for intravitreal injection is subsumed into 67028. Do not add 65800 to the claim — it will either be denied outright or generate an overpayment that could trigger compliance review.

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Example 7 — Bilateral Acute Angle-Closure Crisis

Clinical Scenario:
A 58-year-old hyperopic female presents with bilateral acute angle-closure glaucoma. IOP is 62 mmHg OD and 58 mmHg OS. AC paracentesis is performed on both eyes sequentially at the slit lamp. IOP reduces to 18 mmHg OD and 16 mmHg OS. Bilateral laser iridotomies are scheduled for the following day.

ICD-10-CM:

• H40.2130 — Acute angle-closure glaucoma, bilateral, stage unspecified

CPT:

• 65800-50 — Paracentesis of anterior chamber, bilateral (Modifier -50 for bilateral procedure in the same session)

Modifier -50 billing: When the same procedure is performed on both eyes in the same session, report the CPT code once with Modifier -50. Some payers require the code to be listed twice (once with -RT and once with -LT) rather than once with -50. Follow payer-specific billing guidance for bilateral eye procedures.

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Key Coding Pitfalls & Tips

• 65800 is only for aqueous removal — not blood, not vitreous. The moment the content removed shifts from pure aqueous to blood (65815) or vitreous (65810), the appropriate code changes. Never default to 65800 when a more specific content-based code is available. Let the documented content of the aspirate — and the clinical intention — determine the code.

• 65800 is bundled with 67028 (intravitreal injection) on the same eye at the same session. This is one of the most consequential NCCI bundles in all of ophthalmology. When an AC tap is performed preparatory to or concurrent with intravitreal injection, 65800 cannot be separately billed. Only 67028 is reportable.

• 65800 and 67025 are NOT bundled — both are separately payable. This distinction from the 67028 bundle surprises many coders. For pneumatic retinopexy or other gas/fluid-exchange procedures using 67025, AC tap (65800) can be separately reported with -51.

• 65800-65815 cannot be reported together on the same eye at the same encounter. These three “separate procedure” codes are mutually exclusive per NCCI — report only the most comprehensive and clinically accurate single code from this family.

• The routine paracentesis wound created during cataract surgery is NOT separately coded 65800. Every phacoemulsification procedure (66984, 66982) includes the creation of one or more paracentesis wounds as a standard technique component. These are not separately billable with 65800.

• Modifier -RT or -LT is mandatory. Always lateralize eye procedure codes. Claims without laterality modifiers on eye procedures are frequently rejected at the MAC level and by commercial payers.

• CRAO is a stroke equivalent — code all concurrent vascular diagnoses. When 65800 is performed for CRAO, the concurrent neurological and vascular workup generates additional diagnosis codes (AF, carotid disease, hypertension, diabetes, hyperlipidemia) that are essential for accurate risk capture and for supporting the medical necessity of urgent referral.

• Document the aqueous tap as a distinct procedure, not just a notation. A full procedure note for 65800 must include: indication; confirmation of pre-procedure status (IOP, anterior segment findings); technique (needle gauge, entry site, volume aspirated, appearance of aspirate); post-procedure IOP; confirmation of wound integrity; and any samples sent for analysis. Without a proper procedure note, the claim cannot be substantiated.

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Related Codes (Cross-Reference)

Code	Type	Description
65810	CPT	Paracentesis, anterior chamber; with removal of vitreous and/or discission of anterior hyaloid membrane
65815	CPT	Paracentesis, anterior chamber; with removal of blood, with or without irrigation and/or air injection
65820	CPT	Goniotomy
65855	CPT	Trabeculoplasty by laser surgery (SLT/ALT)
66020	CPT	Injection, anterior chamber; air or liquid (separate procedure)
66030	CPT	Injection, anterior chamber; medication
66761	CPT	Iridotomy/iridectomy by laser surgery
67015	CPT	Aspiration or release of vitreous, subretinal or choroidal fluid, pars plana approach
67025	CPT	Injection of vitreous substitute, pars plana or limbal approach — NOT bundled with 65800
67028	CPT	Intravitreal injection — BUNDLED with 65800 per NCCI
92014	CPT	Comprehensive ophthalmological exam, established patient
92012	CPT	Intermediate ophthalmological exam, established patient
92132	CPT	OCT anterior segment
H34.11	ICD-10-CM	CRAO, right eye
H34.12	ICD-10-CM	CRAO, left eye
H40.2110	ICD-10-CM	Acute AACG, right eye, stage unspecified
H40.2120	ICD-10-CM	Acute AACG, left eye, stage unspecified
H40.051	ICD-10-CM	Ocular hypertension, right eye
H40.052	ICD-10-CM	Ocular hypertension, left eye
H21.01	ICD-10-CM	Hyphema, right eye
H21.02	ICD-10-CM	Hyphema, left eye
H44.001	ICD-10-CM	Purulent endophthalmitis, unspecified, right eye
H44.002	ICD-10-CM	Purulent endophthalmitis, unspecified, left eye
H20.011	ICD-10-CM	Primary iridocyclitis, right eye
H20.012	ICD-10-CM	Primary iridocyclitis, left eye
B00.51	ICD-10-CM	Herpesviral iridocyclitis
B02.32	ICD-10-CM	Zoster iridocyclitis

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Last Reviewed: 2026-02-18 | Source: AMA CPT Professional Edition 2025, CMS MPFS 2025, CMS NCCI Policy Manual 2025 Chapter 8, Retina Today Advanced Coding References, Ophthalmology Management Coding & Compliance, ASRS Advanced Retina Coding, Glaucoma Today ICD-10-CM Reference, ICD-10-CM FY2025