S05.22XA — Ocular Laceration and Rupture with Prolapse or Loss of Intraocular Tissue, Left Eye, Initial Encounter

Code Overview

S05.22XA is a billable ICD-10-CM diagnosis code for ocular laceration and rupture with prolapse or loss of intraocular tissue, left eye, initial encounter. It belongs to the S05.2 subcategory within S05 (Injury of eye and orbit), Chapter 19 (Injury, Poisoning and Certain Other Consequences of External Causes, S00-T88).

This code represents an open globe injury — one of the most serious ophthalmic emergencies in clinical practice, involving a full-thickness wound of the ocular wall (cornea and/or sclera) with prolapse or loss of intraocular contents (uveal tissue, vitreous, lens, or retina). The 7th character “A” designates the initial encounter, and the “X” in positions 5 and 6 are mandatory structural placeholders.

Note

S05.22XA is critically distinct from S05.32XA (ocular laceration without prolapse or loss of tissue) — the presence of prolapsed or extruded intraocular tissue indicates a more severe injury with different surgical management, worse visual prognosis, and higher resource utilization.

Full Code Description

Element	Detail
Full Code	S05.22XA
Description	Ocular laceration and rupture with prolapse or loss of intraocular tissue, left eye, initial encounter
Laterality	Left eye (OS)
7th Character	A = initial encounter
Placeholder	X in positions 5 and 6 — structural placeholders, no clinical meaning
Billable	Yes
Chapter	19 — Injury, Poisoning and Certain Other Consequences of External Causes
Block	S00-S09 — Injuries to the head
Category	S05 — Injury of eye and orbit
Subcategory	S05.2 — Ocular laceration and rupture with prolapse or loss of intraocular tissue
Open Globe	Yes — full-thickness wound of ocular wall with tissue extrusion
Valid FY	FY2025 (Oct 1, 2024 - Sep 30, 2025)

Clinical Description

Open Globe Injury — Definition and Classification

An open globe injury is defined as any full-thickness wound of the corneoscleral wall of the eye. S05.22XA specifically captures the scenario where this full-thickness injury is accompanied by prolapse or loss of intraocular tissue — including uveal tissue (iris, ciliary body, choroid), vitreous, lens material, or retina extruding through or being lost from the wound.

The Birmingham Eye Trauma Terminology (BETT) system is the internationally accepted classification framework:

Term	Definition
Closed globe	No full-thickness wound of the ocular wall
Open globe	Full-thickness wound of the cornea and/or sclera
Rupture	Full-thickness wound caused by blunt force (inside-out mechanism; the eye bursts at its weakest point)
Laceration	Full-thickness wound caused by a sharp object (outside-in mechanism)
Penetrating injury	Single full-thickness wound; no exit wound
Perforating injury	Two full-thickness wounds (entry and exit); the object passed through the entire globe
Intraocular foreign body (IOFB)	Retained foreign object inside the globe after entry wound

Note

S05.22XA encompasses both laceration (sharp mechanism) and rupture (blunt mechanism) of the left eye when either is accompanied by prolapse or loss of intraocular tissue.

Anatomy and Tissue Prolapse

The ocular wall consists of three layers:

Cornea and sclera — the outer fibrous coat (the structural wall)
Uveal tract — the middle vascular coat: iris (anterior), ciliary body (middle), choroid (posterior)
Retina — the inner neural coat

In open globe injuries with prolapse, the following tissues may be extruded:

Iris prolapse — the most commonly prolapsed tissue in anterior segment injuries; the iris plugs the wound, often darkly pigmented, appearing in or protruding from a corneal or limbal laceration
ciliary body prolapse — dark tissue prolapsing in limbal or anterior scleral wounds; carries risk of cyclodialysis and hypotony
Vitreous extrusion — gel-like vitreous prolapsing through the wound or into the anterior chamber; significantly complicates surgical repair
Choroidal extrusion — posterior segment injuries with choroidal tissue visible at wound margins
Lens material extrusion — disrupted lens matter in the wound or anterior chamber
Retinal prolapse — extremely severe; posterior segment trauma with retinal tissue at wound margins; implies severe disruption of posterior anatomy

Mechanisms of Injury

Blunt trauma (rupture mechanism):

Falls onto hard surfaces (striking the orbital rim or eye directly)
Sports injuries — racquet sports, projectiles, contact sports
MVA — airbag deployment (paradoxically causes open globe despite padded impact), seatbelt tension
Assault (fist, blunt objects)
Industrial accidents (high-force blunt impact)
The globe typically ruptures at its weakest points: the limbus, surgical scars from prior eye surgery, or the insertion of extraocular muscles

Sharp/penetrating trauma (laceration mechanism):

Metal fragments — hammering metal on metal, grinding, industrial work (most common IOFB mechanism)
Glass shards — MVA windshield, broken bottles
Projectiles — BB guns, airsoft pellets, nails
Knives and other sharp implements
Wood splinters
Pen tips, pencils, scissors — common in children and domestic settings

Clinical Presentation and Examination

History hallmarks:

Sudden severe pain and visual loss at the time of injury
History of sharp trauma, high-velocity projectile, blunt impact, or blast
Patient may note “something came out of the eye”
Prior ocular surgery is a significant risk factor (surgical scar = weakest point)

Examination findings suggesting open globe with prolapse:

Peaked or irregular pupil — the iris is pulled toward the wound by prolapse; teardrop-shaped or D-shaped pupil
Uveal tissue visible at wound — dark tissue (iris, ciliary body) visible in or extruding from a corneal, limbal, or scleral wound
Flat anterior chamber — loss of aqueous from the wound collapses the AC; may appear as extremely shallow or absent AC on slit lamp
hypotony — markedly low IOP (may be immeasurable or very low); strong sign of open globe — DO NOT measure IOP with applanation tonometry in suspected open globe (may extrude intraocular contents)
Vitreous in anterior segment or at wound — clear gel in the wound or anterior chamber
Positive Seidel test — fluorescein dye washes away from the wound margin in a streaming pattern, indicating aqueous leakage
Bloody chemosis or subconjunctival hemorrhage obscuring view of posterior scleral wound
Hyphema — blood in the anterior chamber
Loss of red reflex — indicates media opacities (hemorrhage, lens disruption, vitreous blood)
Visible retinal tissue — extreme posterior injuries

Warning

Critical examination protocol: When an open globe is suspected, DO NOT apply pressure to the eye, do not use applanation tonometry, do not attempt forced duction testing, minimize lid manipulation, place a rigid metal Fox shield (not a patch) over the eye, keep NPO, administer antiemetics, and arrange urgent ophthalmology and OR.

Visual Prognosis

Visual prognosis for open globe injuries is classified by the Ocular Trauma Score (OTS) and correlates with:

Initial visual acuity at presentation
Presence of afferent pupillary defect (APD)
Ruptured globe (vs. laceration)
Endophthalmitis development
Retinal detachment
Zone of injury (Zone I = anterior to limbus; Zone II = up to 5mm behind limbus; Zone III = > 5mm posterior)
Prolapse or loss of intraocular tissue is associated with worse visual prognosis

7th Character Table

7th Char	Full Code	Description	When to Use
A	S05.22XA	Initial encounter	Active treatment phase; ED, hospitalization, primary surgical repair, any initial care provider
D	S05.22XD	Subsequent encounter	Routine follow-up visits after primary repair; healing/recovery phase
S	S05.22XS	Sequela	Late effects attributable to the healed open globe injury (e.g., phthisis bulbi, chronic pain, blindness, enucleation)

Note

Use “A” throughout the active treatment phase. Per ICD-10-CM Official Guidelines, initial encounter (A) is used for every visit while the patient is actively receiving treatment for the injury. A patient seen by a new provider on week 3 of hospitalization is still coded with “A.” Switch to “D” only when the injury is healing and the patient is in the routine follow-up/recovery phase.

Code Structure / Code Tree

S00-T88    Injury, poisoning and certain other consequences of external causes
  └── S00-S09    Injuries to the head
        └── S05    Injury of eye and orbit
              │    Includes: open wound of eye and orbit
              │
              ├── S05.0    Injury of conjunctiva and corneal abrasion without foreign body
              ├── S05.1    Contusion of eyeball and orbital tissues
              ├── S05.2    Ocular laceration and rupture WITH prolapse or loss of intraocular tissue   ◄ SUBCATEGORY
              │     ├── S05.20    ... unspecified eye
              │     │     ├── [[S05.20XA]]    ... initial encounter
              │     │     ├── [[S05.20XD]]    ... subsequent encounter
              │     │     └── [[S05.20XS]]    ... sequela
              │     ├── S05.21    ... right eye
              │     │     ├── [[S05.21XA]]    ... initial encounter
              │     │     ├── [[S05.21XD]]    ... subsequent encounter
              │     │     └── [[S05.21XS]]    ... sequela
              │     └── S05.22    ... left eye    ◄ PARENT (non-billable)
              │           ├── S05.22XA    ... initial encounter    ◄ THIS CODE
              │           ├── [[S05.22XD]]    ... subsequent encounter
              │           └── [[S05.22XS]]    ... sequela
              ├── S05.3    Ocular laceration WITHOUT prolapse or loss of intraocular tissue
              │     ├── [[S05.30XA]]    ... unspecified eye
              │     ├── [[S05.31XA]]    ... right eye, initial encounter
              │     └── [[S05.32XA]]    ... left eye, initial encounter
              ├── S05.4    Penetrating wound of orbit with or without foreign body
              ├── S05.5    Penetrating wound with foreign body of eyeball
              │     ├── [[S05.51XA]]    ... right eye
              │     └── [[S05.52XA]]    ... left eye
              ├── S05.6    Penetrating wound without foreign body of eyeball
              ├── S05.7    Avulsion of eye
              ├── S05.8    Other injuries of eye and orbit
              └── S05.9    Unspecified injury of eye and orbit

Tip

Critical code selection decision: S05.22XA vs S05.32XA: The presence or absence of prolapse or loss of intraocular tissue is the pivotal distinction. If the wound is full-thickness but all intraocular structures remain in place (e.g., a small corneal laceration that is watertight with no iris prolapse), use S05.32XA. If uveal tissue, vitreous, lens material, or retina prolapses into or through the wound, or if intraocular tissue is lost (extruded to the exterior), use S05.22XA. This distinction has direct surgical and prognostic implications.

Includes / Excludes Notes

Includes (S05 Category Level)

Open wound of eye and orbit (all S05 codes)
Ocular lacerations from both sharp (laceration) and blunt (rupture) mechanisms
Full-thickness wounds of the cornea, limbus, and sclera
Both penetrating (one wound) and perforating (two wounds — entry and exit) injuries when tissue prolapse is present

Excludes2 (S05 Category — May Code Additionally When Present)

These conditions are not included in S05 but may coexist and be separately coded:

Code	Description	Coding Note
S04.0-	2nd cranial (optic) nerve injury	If optic nerve is directly injured — code additionally
S04.1-	3rd cranial (oculomotor) nerve injury	If CN III injury documented
S01.1-	Open wound of eyelid and periocular area	Eyelid lacerations are coded separately from globe lacerations
S02.1-, S02.3-, S02.8-	Orbital bone fracture	Orbital wall fractures coded separately
S00.1-S00.2	Superficial injury of eyelid	Conjunctival/eyelid abrasions coded separately

Code Also (Instructional — Add When Documented)

Code	Description
S06.-	Any associated intracranial injury
S05.4-	Any associated perforating wound of orbit
S05.52XA	Penetrating wound with foreign body of left eyeball (add when IOFB is documented in the left eye)
T15.-	Foreign body on external eye (if superficial foreign body is also present)

External Cause Codes Required

External Cause Code	Description
W28.XXXA	Contact with powered lawnmower, initial
W45.0XXA	Nail entering through skin/eye, initial
W45.8XXA	Other foreign body or object entering through skin/eye, initial
W29.8XXA	Contact with other powered hand tools, initial
W50.4XXA	Accidental strike by sports equipment, initial
X58.XXXA	Exposure to other specified factors, initial
V49.50XA	Driver injured in collision, unspecified vehicle, initial
Y99.0	Civilian activity done for income or pay
Y99.8	Other external cause status

HCC (Hierarchical Condition Category) Mapping

S05.22XA does NOT map to a CMS-HCC in any current risk adjustment model for the acute injury itself.

HCC Model	HCC Assignment	RAF Impact
CMS-HCC Model V28	Not assigned	No RAF
RxHCC Model	Not assigned	No RAF
HHS-HCC (ACA Marketplace)	Not assigned	No RAF

Note

Sequela HCC opportunity: The long-term consequences of open globe injuries may generate HCC-relevant conditions. Blindness or low vision codes (H54.-) do map to HCC categories in some models. Phthisis bulbi (H44.52) may also be relevant for ongoing care documentation. Permanent monocular blindness from open globe injury, when coded appropriately in the chronic care setting with sequela codes, contributes to accurate RAF in qualifying models.

MS-DRG Mapping (Inpatient)

Open globe injuries almost universally require inpatient surgical management. S05.22XA is explicitly identified in the CMS MS-DRG v41.0 definitions manual as a code mapping to the eye disorders DRG family.

MS-DRG	Description	Trigger
124	Other Disorders of the Eye with MCC	S05.22XA as PDx + qualifying MCC
125	Other Disorders of the Eye without MCC	S05.22XA as PDx, no MCC

MDC: MDC 02 — Diseases and Disorders of the Eye

If surgical repair (ORIF/open globe repair) is performed:

When operative repair (CPT 65285 maps to ICD-10-PCS for inpatient) is performed during the admission, the DRG shifts to surgical DRGs within MDC 02:

MS-DRG	Description
117	Intraocular Procedures with MCC
118	Intraocular Procedures with CC
119	Intraocular Procedures without CC/MCC

CC/MCC Status:

S05.22XA functions as a CC when appearing as a secondary diagnosis in certain DRG contexts, contributing to severity upgrade
As primary diagnosis, drives grouping to DRG 124/125 or surgical equivalents

CPT Procedure Codes (Commonly Associated)

Diagnostic and Emergency Management

CPT	Description	wRVU (approx.)	Notes
99284	ED visit, high severity	2.60	Initial ED evaluation
99285	ED visit, high severity with threat to function	3.80	Complex trauma presentations
92002	Ophthalmological medical service, new patient, intermediate	1.43	When ophthalmology evaluates in the ED
70486	CT maxillofacial without contrast	1.50	For orbital fracture evaluation
70487	CT maxillofacial with contrast	1.90	Vascular injury, retained FB
72125	CT cervical spine	1.50	If associated neck trauma
76529	Ophthalmic ultrasound, diagnostic B-scan	0.93	If posterior segment not visualizable; DO NOT place probe directly on open globe — use closed-lid technique or avoid

Important

Imaging caution: Direct applanation tonometry and probe contact with an open globe is contraindicated. B-scan ultrasound should be performed with minimal pressure, closed-lid technique, or deferred until after primary repair if the wound is insecure.

Primary Open Globe Repair (Surgical)

These CPT codes cover the repair of the ocular laceration/rupture. Code selection is based on wound location and complexity:

CPT	Description	wRVU (approx.)	Assistant Allowed?
65270	Repair of laceration; conjunctiva, with or without nonperforating laceration of sclera, direct closure	~5.78	No
65272	Repair of laceration; conjunctiva, by mobilization and rearrangement, without hospitalization	~6.84	No
65273	Repair of laceration; conjunctiva, by mobilization and rearrangement, with hospitalization	~8.19	No
65275	Repair of laceration; cornea, nonperforating, with or without removal of foreign body	~8.67	No
65280	Repair of laceration; cornea and/or sclera, perforating, not involving uveal tissue	~16.33	No
65285	Repair of laceration; cornea and/or sclera, perforating, with reposition or resection of uveal tissue	~22.80	Yes
65286	Repair of laceration; application of tissue glue, wounds of cornea and/or sclera	~6.50	No

S05.22XA → CPT 65285 is the primary pairing. Because S05.22XA specifically requires prolapse or loss of intraocular (uveal) tissue, CPT 65285 (perforating repair with repositioning or resection of uveal tissue) is the most clinically accurate match. CPT 65280 applies when the wound is perforating but uveal tissue is not involved. CPT 65285 allows an assistant surgeon.

Additional Procedures Commonly Performed Concurrently (Same Session)

In complex open globe injuries, multiple procedures are performed at the same surgical sitting. The following may be separately reported when distinct from the primary repair:

CPT	Description	wRVU (approx.)	Assistant Allowed?	Notes
65235	Removal of foreign body; intraocular, from anterior chamber of eye or lens	~9.69	No	For IOFB in anterior segment
65260	Removal of foreign body; intraocular, from posterior segment, magnetic extraction, anterior or posterior route	~19.15	No	Magnetic IOFB posterior
65265	Removal of foreign body; intraocular, from posterior segment, nonmagnetic extraction	~22.11	No	Nonmagnetic IOFB posterior
67036	Vitrectomy, mechanical, pars plana approach	~21.46	No	For vitreous hemorrhage, prolapsed vitreous management
67108	Repair of retinal detachment with vitrectomy	~33.77	No	If retinal detachment concurrent
66850	Removal of lens material; phacofragmentation technique with aspiration	~8.46	No	Traumatic lens disruption
66984	Extracapsular cataract removal with IOL implant	~9.81	No	If IOL implantation performed
65800	Paracentesis of anterior chamber; with removal of aqueous (washout of hyphema)	~3.73	No	For traumatic hyphema
67028	Intravitreal injection of pharmacologic agent (antibiotics — endophthalmitis prophylaxis)	~1.60	No

Bundling note:

When multiple procedures are performed during primary open globe repair, check NCCI edits for bundling between pairs. Some anterior and posterior segment procedures have CCI edits that apply — for example, vitrectomy (67036) performed as part of the open globe repair may not be separately billable in all contexts. Always refer to the current NCCI edit table and payer policy.

Post-Repair Follow-up and Secondary Procedures

CPT	Description	wRVU (approx.)	Assistant Allowed?
92014	Comprehensive ophthalmological exam	1.50	No
92134	OCT posterior segment (follow-up)	0.58	No
92235	Fluorescein angiography	1.10	No
67041	Vitrectomy with membrane peel (if ERM develops)	~17.60	Yes
65920	Removal of IOL (if traumatic IOL repositioning needed)	~9.48	No
65930	Removal of blood clot, anterior chamber	~5.09	No
65780	Ocular surface reconstruction, amniotic membrane	~9.48	No
65175	Enucleation (if eye is unsalvageable, phthisis bulbi)	~15.35	No
65105	Enucleation with implant, muscles not attached	~17.78	No
65125	Modification of ocular implant with implant, muscles not attached	~9.48	No

Coding Examples

Example 1 — Iris Prolapse from Corneal Laceration, Left Eye

Clinical Scenario:
A 34-year-old male presents to the ED after a glass shard struck his left eye during an MVA. He reports immediate severe pain and vision loss OS. Examination reveals a 5 mm corneal laceration at the 9 o’clock position with dark uveal tissue (iris) prolapsing through the wound, shallow anterior chamber, and hypotony. Visual acuity is LP (light perception) OS. He is taken to the OR emergently for open globe repair.

ICD-10-CM:

S05.22XA — Ocular laceration and rupture with prolapse or loss of intraocular tissue, left eye, initial encounter
S05.32XA — Ocular laceration without prolapse, left eye (do NOT use — S05.22XA already captures the injury with prolapse; this would be incorrect)
V49.50XA — Driver injured in collision, unspecified vehicle in traffic accident, initial encounter
Y99.8 — Other external cause status

CPT:

65285-LT — Repair of laceration, cornea and/or sclera, perforating, with reposition or resection of uveal tissue, left eye
99284 — ED visit, high severity (if E/M is separately billable — verify global period and payer rules)

Assistant surgeon: Yes — CPT 65285 allows assistant billing.

Example 2 — Ruptured Globe OS with Vitreous Loss and IOFB

Clinical Scenario:
A 48-year-old male auto mechanic is hammering metal when a fragment strikes his left eye. He presents with marked visual loss OS, irregular pupil, vitreous prolapse through a 8 mm scleral laceration at the limbus, and an intraocular foreign body (metallic) visible on CT in the vitreous cavity. He is taken emergently to the OR for open globe repair, IOFB removal, and pars plana vitrectomy.

ICD-10-CM:

S05.22XA — Ocular laceration and rupture with prolapse or loss of intraocular tissue, left eye, initial encounter
S05.52XA — Penetrating wound with foreign body of left eyeball, initial encounter (code also — IOFB present)
W45.8XXA — Other foreign body or object entering through skin/eye (metallic fragment), initial encounter
Y99.0 — Civilian activity done for income/pay (occupational injury)

CPT:

65285-LT — Open globe repair, perforating, with reposition of uveal tissue (primary repair)
65265-LT — Removal of IOFB, posterior segment, nonmagnetic extraction (separately reportable; check NCCI)
67036-LT — vitrectomy, mechanical, pars plana approach (for vitreous hemorrhage and surgical access)

Assistant surgeon: Yes for 65285; No for 67036 and 65265 per MPFS indicator — verify current year.

Example 3 — Globe Rupture from Blunt Trauma (Hammer-Blow Mechanism), Left Eye with Retinal Detachment

Clinical Scenario:
A 55-year-old female is struck on her left eye with a hammer handle during an assault. She presents with no light perception OS, marked subconjunctival hemorrhage, hypotony, and posterior scleral rupture with vitreous and retinal tissue prolapse through the posterior wound. CT shows posterior wall disruption. In the OR, the surgeon finds Zone III rupture with retinal prolapse and vitreous loss; concurrent rhegmatogenous retinal detachment is confirmed during surgery.

ICD-10-CM:

S05.22XA — Ocular laceration and rupture with prolapse or loss of intraocular tissue, left eye, initial encounter
H33.052 — Total retinal detachment, left eye (concurrent traumatic RD — code also)
W50.0XXA — Accidental hit/strike by another person, initial encounter

CPT:

65285-LT — Open globe repair with reposition of uveal tissue
67108-LT — Repair of retinal detachment with vitrectomy (concurrent RD repair — verify NCCI bundling with 65285)
Modifier -22 — Increased procedural complexity may be appropriate given Zone III injury with retinal prolapse; document in the operative note

Example 4 — Pediatric Open Globe, Left Eye (Pencil Injury)

Clinical Scenario:
A 7-year-old boy falls while running with a pencil; the pencil tip penetrates the left globe through the inferior cornea with iris prolapse and anterior lens disruption. Presenting VA is CF (counting fingers) OS. He undergoes primary repair and lens removal.

ICD-10-CM:

S05.22XA — Ocular laceration and rupture with prolapse or loss of intraocular tissue, left eye, initial encounter
W21.89XA — Struck by other specified sports equipment (or more appropriate external cause for pencil — W45.8XXA — other foreign body entering through skin)
Y93.89 — Activity, other specified

CPT:

65285-LT — Open globe repair with uveal reposition
66850-LT — Removal of lens material, phacofragmentation (traumatic lens removal during repair)

Pediatric note: Traumatic cataract and amblyopia management following open globe injury in children requires long-term follow-up coding. Subsequent IOL implantation (66984 or 66985) and amblyopia treatment (99177 for occlusion therapy) may be separately reported at later encounters.

Example 5 — Encounter Type Progression (A → D → S)

Same patient as Example 1:

ED + surgical admission (active treatment): S05.22XA — initial encounter
2-week post-op office visit (suture removal, wound healing check): S05.22XD — subsequent encounter
6 months later (phthisis bulbi OS, blind painful eye, chronic pain): S05.22XS + H44.522 — phthisis bulbi, left eye, as sequela of open globe injury

Key Coding Pitfalls & Tips

S05.22XA vs S05.32XA — tissue prolapse is the defining distinction. S05.32XA is for ocular laceration/rupture without prolapse or loss of tissue — a less severe open globe. When uveal tissue, vitreous, or other intraocular contents prolapse into or through the wound, S05.22XA is mandatory. This distinction affects surgical CPT code selection (65285 vs 65280) and should be clearly documented in the operative note.
“X” placeholders are required. The full code must be written S05.22XA — not S05.22A. Positions 5 and 6 are occupied by the placeholder “X,” which is structurally required to reach the 7th character position.
Always code the external cause. All S05.- codes require external cause codes (V/W/X/Y) for mechanism, place of occurrence, and activity when documented.
Code also IOFB when present. If an intraocular foreign body is documented, add S05.52XA (penetrating wound with IOFB, left eye) — these are not mutually exclusive. The open globe with prolapse and the IOFB are distinct injury components that should both be coded.
Code also orbital fractures separately. If orbital fractures coexist with the open globe (common in high-velocity trauma), add S02.- codes per the Excludes2 instruction.
Do not confuse with eyelid laceration codes. S01.1- (open wound of eyelid and periocular area) is separately coded from S05.22XA (globe laceration). Both can occur simultaneously — code both if documented.
Initial encounter (A) throughout entire active treatment. The “A” 7th character is used for every visit during active treatment — ED, hospitalization, surgical sessions, and even early postoperative visits where the injury is still being actively managed. Switch to “D” (subsequent) only when the wound is in the healing/recovery phase.
Bundling awareness for combined procedures. When primary open globe repair (65285) and concurrent procedures (IOFB removal, vitrectomy, retinal repair) are performed in the same session, NCCI edits may bundle certain CPT pairs. Always check current NCCI edits before submitting multiple procedure codes. Modifier -59 or XU/XS/XE/XP may be needed to unbundle legitimately separate procedures.

Code	Description
S05.21XA	Ocular laceration and rupture with prolapse, right eye, initial encounter
S05.20XA	Ocular laceration and rupture with prolapse, unspecified eye — avoid when laterality is known
S05.22XD	Ocular laceration and rupture with prolapse, left eye, subsequent encounter
S05.22XS	Ocular laceration and rupture with prolapse, left eye, sequela
S05.32XA	Ocular laceration without prolapse, left eye — use when no uveal/tissue prolapse
S05.52XA	Penetrating wound with foreign body of left eyeball — code also when IOFB present
S05.62XA	Penetrating wound without foreign body of left eyeball
S05.72XA	Avulsion of left eye, initial encounter
S05.42XA	Penetrating wound of orbit with foreign body, left side
S04.02XA	Injury of optic nerve, left eye, initial encounter
S01.12XA	Open wound of left eyelid and periocular area (code separately if eyelid also lacerated)
S02.122A	Fracture of orbital roof, left side (code separately if orbital fracture coexists)
H33.052	Total retinal detachment, left eye
H44.522	Phthisis bulbi, left eye (sequela code for unsalvageable eye)
H54.62	Blindness, left eye, normal vision right eye (long-term visual loss sequela)
T15.02XA	Foreign body in cornea, left eye, initial encounter
Z87.39	Personal history of other physical injuries and trauma

Last Reviewed: 2026-02-18 | Source: ICD-10-CM FY2025, CMS MPFS, CMS MS-DRG v41.0, BETT Classification System, AAPC Eye Laceration Coding Guidelines, Retina Today Coding Reference, AAO Open Globe Preferred Practice Pattern

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S05.22XA

S05.22XA — Ocular Laceration and Rupture with Prolapse or Loss of Intraocular Tissue, Left Eye, Initial Encounter

Code Overview

Full Code Description

Clinical Description

Open Globe Injury — Definition and Classification

Anatomy and Tissue Prolapse

Mechanisms of Injury

Clinical Presentation and Examination

Visual Prognosis

7th Character Table

Code Structure / Code Tree

Includes / Excludes Notes

Includes (S05 Category Level)

Excludes2 (S05 Category — May Code Additionally When Present)

Code Also (Instructional — Add When Documented)

External Cause Codes Required

HCC (Hierarchical Condition Category) Mapping

MS-DRG Mapping (Inpatient)

CPT Procedure Codes (Commonly Associated)

Diagnostic and Emergency Management

Primary Open Globe Repair (Surgical)

Additional Procedures Commonly Performed Concurrently (Same Session)

Post-Repair Follow-up and Secondary Procedures

Coding Examples

Example 1 — Iris Prolapse from Corneal Laceration, Left Eye

Example 2 — Ruptured Globe OS with Vitreous Loss and IOFB

Example 3 — Globe Rupture from Blunt Trauma (Hammer-Blow Mechanism), Left Eye with Retinal Detachment

Example 4 — Pediatric Open Globe, Left Eye (Pencil Injury)

Example 5 — Encounter Type Progression (A → D → S)

Key Coding Pitfalls & Tips

Related Codes (Cross-Reference)

Graph View

Table of Contents

Recent Notes