👁️ CPT 65235 — Removal Of Foreign Body, Intraocular; From Anterior Chamber Of Eye Or Lens
Quick Reference
wRVU: 8.78 | Global Period: 090 | Assistant Payable: Yes (Indicator 02) | Bilateral Indicator: 1
Rule: CPT 65235 is subject to a 90-day major surgical global period. The bilateral indicator of 1 means a 150% payment adjustment applies if performed on both eyes during the same session. An assistant surgeon is payable under Medicare guidelines if documented medical necessity is established (Indicator 02).
📋 Clinical Description
CPT 65235 describes the surgical removal of a foreign body that has penetrated the eye and lodged within the anterior chamber or the crystalline lens. The provider typically utilizes a surgical operating microscope to visualize the foreign body and constructs a precise clear corneal, limbal, or scleral entry incision to access the anterior segment of the eye. Viscoelastic material is routinely injected into the anterior chamber to maintain depth, protect the corneal endothelium, and stabilize intraocular structures during extraction. Utilizing specialized intraocular forceps, micro-hooks, or an intraocular magnet, the provider carefully grasps and withdraws the foreign object from the eye.
Following the extraction of the intraocular foreign body, the provider performs meticulous irrigation of the anterior chamber to ensure no residual particulate matter, lens debris, or blood remains. The surgical incision is then securely closed using fine sutures (e.g., 10-0 nylon) or hydrated to achieve a watertight seal, and intraocular pressure is verified to prevent post-procedural hypotony or wound leaks. Antibiotic and anti-inflammatory agents are administered topically or subconjunctivally to minimize the risk of endophthalmitis. Unlike 65222, which involves a superficial corneal foreign body removed via slit lamp without entering the globe, CPT 65235 requires intraocular penetration and surgical access to the anterior segment. Furthermore, CPT 65235 is distinguished from 65260, which targets foreign bodies lodged in the posterior segment (vitreous cavity or retina).
This procedure may be performed in the following clinical contexts:
- Traumatic Occupational Injury — An industrial worker sustains a high-velocity injury where a metallic fragment penetrates the cornea and rests in the anterior chamber angle. The provider performs emergent intraocular extraction to prevent siderosis bulbi and permanent corneal endothelial damage.
- Recreational Trauma — A patient suffers a penetrating projectile injury that enters the crystalline lens. Emergency surgical removal is performed to extract the intraocular foreign body and prevent rapid traumatic cataract expansion or endophthalmitis.
- Retained Intraocular Surgical Material — During a complex anterior segment surgery, a fragment of a surgical instrument or dislodged intraocular lens material breaks off into the anterior chamber. The surgeon re-enters the anterior chamber to retrieve the retained foreign body and protect intraocular tissues.
- Organic Foreign Body Penetration — A gardener or outdoor worker suffers a penetrating ocular injury from a plant thorn or wood particle lodged in the anterior segment. Immediate surgical removal is required due to the extreme risk of fulminant fungal or bacterial endophthalmitis.
🔬 Anatomical & Procedural Considerations
| Variant | Mechanism | Key Notes |
|---|---|---|
| Metallic Object | Extracted using a specialized intraocular magnet or delicate micro-grasping forceps via a corneal or limbal incision. | Intraocular metallic objects containing iron or copper cause severe chemical toxicity (siderosis or chalcosis) if retained. Prompt removal is mandated to preserve retinal function and corneal integrity. |
| Glass / Plastic | Extracted utilizing smooth-jawed intraocular forceps to prevent shattering or particulate migration during withdrawal. | Non-metallic inert materials do not cause chemical toxicity but present severe mechanical risks to the iris and corneal endothelium. Visualization can be challenging due to optical transparency. |
| Intralenticular Object | Extracted directly from within the crystalline lens structure, frequently accompanied by localized capsular disruption. | Penetration of the lens capsule usually results in a traumatic cataract. The surgeon must evaluate whether to perform isolated foreign body extraction or concurrent lensectomy/cataract extraction. |
Clinical Pearl
When billing for CPT 65235, operative documentation must explicitly describe the intraocular penetration depth and confirm the foreign body’s exact anatomical location within the anterior chamber, iris plane, or crystalline lens. Clear differentiation from extraocular or superficial corneal foreign bodies is required to justify this 90-day major surgical code.
✅ Procedure Includes
- Administration of local, regional, or general anesthesia necessary for intraocular surgery.
- Construction of a corneal, limbal, or scleral incision to gain entry into the anterior segment.
- Injection of ophthalmic viscosurgical devices (OVD) to maintain anterior chamber depth and protect endothelial cells.
- Primary intraocular extraction of foreign body using intraocular forceps, magnets, or specialized micro-instruments.
- Anterior chamber irrigation, aspiration, and removal of exudate, blood, or foreign debris.
- Scleral/corneal wound suture closure, stromal hydration, and verification of watertight intraocular pressure seal.
❌ Excludes / Do Not Report Together
| Code | Description | Relationship |
|---|---|---|
| 65222 | Removal of foreign body, external eye; corneal, with slit lamp | Mutually exclusive on the same eye. CPT 65222 is for superficial corneal foreign bodies without intraocular entry. |
| 65260 | Removal of foreign body, intraocular; from posterior segment, magnetic extraction | Mutually exclusive on the same eye for the same foreign body. Posterior segment extraction targets foreign bodies located behind the lens plane. |
| 65265 | Removal of foreign body, intraocular; from posterior segment, nonmagnetic extraction | Mutually exclusive on the same eye for the same foreign body. Describes non-magnetic posterior segment intraocular extraction. |
| 65800 | Paracentesis of anterior chamber of eye; with removal of aqueous | Bundled. Entry into the anterior chamber and fluid manipulation are inherent components of intraocular extraction under NCCI edits. |
| 66850 / 66984 | Cataract removal / lensectomy techniques | Concurrent cataract extraction during traumatic foreign body removal may be separately billable if medically indicated, subject to NCCI edits and modifier -51 or -59. |
Bundling Alert
CPT 65235 carries a 90-day major surgical global period. Preoperative and postoperative care within 90 days related to the recovery from this surgery is bundled into the surgical fee. Under CMS NCCI edits, minor access steps such as anterior chamber paracentesis, viscoelastic injection, and routine wound closure are completely bundled. If an Evaluation and Management (E/M) service is provided on the day of or day prior to surgery that resulted in the initial decision to perform major surgery, append modifier -57 to the E/M code.
🌳 Code Tree — Surgical Procedures on the Eye and Ocular Adnexa
CPT 65091-68899 Surgery: Eye and Ocular Adnexa
│
├── 65205-65235 Removal of Foreign Body
│ ├── 65205 Removal of foreign body, external eye; conjunctival superficial
│ ├── 65210 Removal of foreign body, external eye; conjunctival embedded (includes concretions), subconjunctival, or scleral nonperforating
│ ├── 65220 Removal of foreign body, external eye; corneal, without slit lamp
│ ├── 65222 Removal of foreign body, external eye; corneal, with slit lamp
│ ├── ▶▶ 65235 ◀◀ Removal of foreign body, intraocular; from anterior chamber of eye or lens ← YOU ARE HERE (Global: 090)
│ ├── 65260 Removal of foreign body, intraocular; from posterior segment, magnetic extraction, anterior or posterior route (Global: 090)
│ └── 65265 Removal of foreign body, intraocular; from posterior segment, nonmagnetic extraction (Global: 090)💰 RVU & Reimbursement Profile
| Component | Value |
|---|---|
| Work RVU | 8.78 |
| Non-Facility PE RVU | NA (9.54) |
| Facility PE RVU | 9.54 |
| Malpractice RVU | 0.71 |
| Total Facility RVU | 19.03 |
| Global Period | 090 |
| Bilateral Indicator | 1 — 150% payment adjustment applies if performed bilaterally |
| Assistant Surgeon | 02 — Payable with documented medical necessity |
| Co‑Surgeon | 00 — Co-surgeons not permitted |
| Team Surgery | 00 — Team surgeons not permitted |
| PC/TC Split | 0 — Physician Service Only (concept does not apply) |
| Modifier -51 Exempt | No — Subject to multiple procedure payment reduction |
| Anesthesia Base Units | 6 (CPT 00140 for intraocular surgical procedures) |
Bilateral Billing Rules
If foreign bodies are extracted from the anterior chambers or lenses of both eyes during the same operative session, append modifier -50 to CPT 65235 (or report with -RT and -LT according to payer preference). Under Bilateral Indicator 1, Medicare processes bilateral claims at 150% of the allowable Physician Fee Schedule rate.
🏷️ Modifier Reference
| Modifier | Name | When to Apply |
|---|---|---|
| -RT | Right Side | Append when the intraocular foreign body extraction is performed on the right eye. |
| -LT | Left Side | Append when the intraocular foreign body extraction is performed on the left eye. |
| -50 | Bilateral | Append when intraocular foreign body extractions are performed on both eyes in the same session. |
| -E1 | Upper Left Eyelid | Not applicable to intraocular procedures; use eye modifiers -LT or -RT. |
| -E2 | Lower Left Eyelid | Not applicable to intraocular procedures; use eye modifiers -LT or -RT. |
| -E3 | Upper Right Eyelid | Not applicable to intraocular procedures; use eye modifiers -LT or -RT. |
| -E4 | Lower Right Eyelid | Not applicable to intraocular procedures; use eye modifiers -LT or -RT. |
| -25 | Significant E/M | Not typically used for 90-day major surgeries; use modifier -57 for decision-for-surgery E/M visits. |
| -24 | Unrelated E/M | Append to an E/M service provided during the 90-day global period for a condition unrelated to the ocular surgery. |
| -51 | Multiple Procedures | Append to CPT 65235 when performed secondarily alongside another major surgical procedure in the same session. |
| -57 | Decision for Surgery | Append to an E/M code on the day of or day before CPT 65235 when the visit resulted in the decision for major surgery. |
| -59 | Distinct Service | Append to bypass NCCI edits when performing a distinctly separate procedural service on a different structure or session. |
| -52 | Reduced Services | Append if the provider partially aborts the procedure after initiation due to technical or clinical factors. |
| -53 | Discontinued Service | Append if the surgical procedure is terminated abruptly prior to completion to protect patient safety. |
| -58 | Staged Procedure | Append if a planned secondary intraocular surgery is performed during the global period of the initial extraction. |
| -78 | Return to OR | Append when a patient requires a return to the operating room during the 90-day global period for a complication (e.g., wound leak). |
| -79 | Unrelated Procedure | Append when an unrelated surgical procedure is performed by the same surgeon during the 90-day global period. |
🩺 Common ICD‑10‑CM Pairings
Primary Diagnosis Group
| ICD‑10 | Description | HCC? | Notes |
|---|---|---|---|
| T15.01XA | Foreign body in cornea, right eye, initial encounter | ❌ No | Indicates penetrating corneal wound with foreign body lodged in anterior chamber of right eye. |
| T15.02XA | Foreign body in cornea, left eye, initial encounter | ❌ No | Indicates penetrating corneal wound with foreign body lodged in anterior chamber of left eye. |
| T15.91XA | Foreign body on external eye, part unspecified, right eye, initial encounter | ❌ No | Avoid unspecified codes when operative report documents intraocular anterior chamber location. |
| H44.641 | Retained (old) magnetic foreign body in anterior chamber, right eye | ❌ No | Describes a retained magnetic foreign body residing long-term in right anterior chamber. |
| H44.742 | Retained (old) nonmagnetic foreign body in anterior chamber, left eye | ❌ No | Describes a retained nonmagnetic foreign body in left anterior chamber. |
Secondary Group
| ICD‑10 | Description | HCC? | Notes |
|---|---|---|---|
| S05.51XA | Penetrating wound with foreign body of right eyeball, initial encounter | ❌ No | Captures acute penetrating ocular trauma associated with right intraocular foreign body. |
| S05.52XA | Penetrating wound with foreign body of left eyeball, initial encounter | ❌ No | Captures acute penetrating ocular trauma associated with left intraocular foreign body. |
Etiology / Complication
| ICD‑10 | Description | HCC? | Notes |
|---|---|---|---|
| H26.111 | Localized traumatic opacities, right eye | ❌ No | Identifies traumatic lens opacity secondary to intralenticular foreign body penetration in right eye. |
| H26.112 | Localized traumatic opacities, left eye | ❌ No | Identifies traumatic lens opacity secondary to intralenticular foreign body penetration in left eye. |
| H20.011 | Primary iridocyclitis, right eye | ❌ No | Captures severe traumatic intraocular anterior segment inflammation secondary to foreign body. |
Coding Specificity Reminder
Always assign the correct 7th-character encounter indicator (A = initial, D = subsequent, S = sequela) for traumatic ocular injury codes. Ensure documentation differentiates magnetic versus nonmagnetic retained foreign bodies (H44.641 vs. H44.742) and includes secondary codes for traumatic cataracts or intraocular inflammation.
🏥 MS‑DRG Considerations
When CPT 65235 is performed in an inpatient facility setting, the surgical procedure maps to MS-DRG 116 (Intraocular Procedures with CC/MCC) or MS-DRG 117 (Intraocular Procedures without CC/MCC). Emergency intraocular foreign body extraction is universally recognized as medically necessary by Medicare National Coverage Determinations (NCDs) and Local Coverage Determinations (LCDs) to prevent blindness, toxicity, and endophthalmitis. All routine inpatient postoperative care directly related to the extraction falls within the 90-day global surgical package.
🔧 ICD‑10‑PCS Equivalents
| PCS Code | Full Description | Modality |
|---|---|---|
| 08C23ZZ | Extirpation of matter from right anterior chamber, percutaneous approach | Extraction |
| 08C33ZZ | Extirpation of matter from left anterior chamber, percutaneous approach | Extraction |
| 08CK3ZZ | Extirpation of matter from right lens, percutaneous approach | Extraction |
| 08CL3ZZ | Extirpation of matter from left lens, percutaneous approach | Extraction |
PCS Character Analysis
| Position | Character | Value | Definition |
|---|---|---|---|
| 1 | Section | 0 | Medical and Surgical section. |
| 2 | Body System | 8 | Eye body system. |
| 3 | Root Operation | C | Extirpation, defined as taking or cutting out solid matter from a body part. |
| 4 | Body Part | 2, 3, K, L | Specifies the exact anatomical site (Right/Left Anterior Chamber or Right/Left Lens). |
| 5 | Approach | 3 | Percutaneous approach, representing entry by needle or minor surgical incision. |
| 6 | Device | Z | No device is left in place following foreign body extraction. |
| 7 | Qualifier | Z | No qualifier is assigned for this procedural section. |
Root Operation Comparison
- Extirpation (C) is the required root operation because solid foreign material is removed from an anatomical structure without removing the structure itself.
- If a traumatic cataract requires concurrent removal of the damaged crystalline lens, report a separate code under root operation Extirpation or Extraction depending on procedural technique.
- Do not code device insertion unless a intraocular lens implant (IOL) is placed during the same session.
📝 Coding Examples
Example 1
Clinical Scenario:
A 35-year-old machinist presents to the ASC following a metal striking injury to the right eye. Slit-lamp examination demonstrates a 1.5 mm metallic shard penetrating the clear cornea and resting in the inferior angle of the right anterior chamber. The provider takes the patient to the operating room, creates a limbal incision, injects viscoelastic, and successfully extracts the metallic foreign body using intraocular forceps. The incision is closed with 10-0 nylon suture and verified watertight.
| Field | Code | Rationale |
|---|---|---|
| CPT | 65235--RT | Captures intraocular foreign body extraction from the anterior chamber of the right eye. |
| PDx | S05.51XA | Identifies penetrating wound with foreign body of right eyeball, initial encounter. |
Note
Because CPT 65235 carries a 90-day global period, routine postoperative follow-up visits within 90 days for this right eye procedure cannot be billed separately.
Example 2
Clinical Scenario:
A 42-year-old patient undergoes surgical removal of a glass foreign body from the left anterior chamber. During the same surgical session, the provider notes that the penetrating injury caused an acute, traumatic cataract with rupture of the anterior lens capsule. The provider extends the limbal incision, performs phacoemulsification of the traumatic cataract, and inserts an intraocular lens (IOL).
| Field | Code | Rationale |
|---|---|---|
| CPT 1 | 66984--LT | Primary procedure: extracapsular cataract removal with IOL insertion in the left eye. |
| CPT 2 | 65235--51--LT | Secondary procedure: intraocular foreign body extraction; modifier -51 indicates multiple procedures. |
| PDx | H26.112 | Traumatic cataract of left eye resulting from penetrating trauma. |
Warning
Example 3
Clinical Scenario:
A patient is evaluated in the emergency department for severe left eye pain following an explosion. The ophthalmologist performs a comprehensive E/M evaluation and determines a glass splinter is embedded in the left crystalline lens. The decision for immediate surgical intervention is made. The patient is taken to the OR where the surgeon extracts the foreign body directly from the lens structure.
| Field | Code | Rationale |
|---|---|---|
| CPT | 65235--LT | Captures intraocular extraction of foreign body from the crystalline lens of left eye. |
| PDx | T15.02XA | Foreign body in cornea/anterior eye, left eye, initial encounter. |
Global period reminder
If the emergency department E/M evaluation was performed by the operating surgeon on the day of surgery, append modifier -57 (Decision for Surgery) to the E/M code to bypass preoperative global bundling.
⚠️ Common Coding Pitfalls
- Pitfall 1: Reporting CPT 65235 for superficial or external corneal foreign bodies. If the foreign object is embedded on the corneal surface without penetrating into the anterior chamber, report CPT 65222 or 65220 instead.
- Pitfall 2: Omitting laterality modifiers. CPT 65235 requires laterality modifier -RT or -LT (or -50 if bilateral); submitting claims without laterality leads to administrative denials.
- Pitfall 3: Unbundling minor procedural steps. Anterior chamber paracentesis (65800), viscoelastic injection, anterior chamber irrigation, and suture closure are integral components of CPT 65235 and cannot be reported separately.
- Pitfall 4: Improperly billing E/M services within the 90-day global period. Postoperative care within 90 days is bundled into CPT 65235 unless the E/M service is for an unrelated condition (modifier -24).
- Pitfall 5: Misidentifying anatomical segment. If the foreign body is located in the posterior segment (vitreous or retina), CPT 65235 is incorrect; report 65260 or 65265 instead.
- Pitfall 6: Omitting the required 7th character on ICD-10-CM trauma codes. Ocular injury codes require an encounter character (A, D, or S) to process properly.
📎 Sources
1. American Medical Association. *CPT® 2026 Professional Edition.* AMA; 2025. 2. Centers for Medicare & Medicaid Services. *Physician Fee Schedule Relative Value Files (PPRRVU2026).* CMS; 2026. https://www.cms.gov/medicare/physician-fee-schedule/search 3. AAPC. *CPT® Code 65235 - Removal of foreign body, intraocular.* Codify by AAPC; 2026. https://www.aapc.com/codes/cpt-codes/65235 4. Find-A-Code. *CPT® 65235 - Removal of foreign body, intraocular; from anterior chamber of eye or lens.* Find-A-Code; 2026. https://www.findacode.com/cpt/65235-cpt-code.htmlSources listed above correspond to superscript citations throughout this note. Verify all Medicare payment figures against your current CMS PFS Lookup tool and applicable MAC LCD prior to claim submission. Please use the latest AAPC/AHIMA Coding Books to verify each code within this note.