Summary & Overview
CPT 65270: Conjunctival Laceration Repair
CPT code 65270 designates surgical repair of a conjunctival laceration with direct closure, and includes closure of any associated nonperforating scleral laceration. This code captures a common ophthalmic minor surgical procedure performed to restore ocular surface integrity and prevent complications such as persistent wound gape, infection, or scarring that can affect vision.
Key national payers relevant to this code include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Coverage and payment policies for 65270 vary by payer and setting, with differences in site-of-service allowances, prior authorization requirements for outpatient procedures, and bundling or global period rules.
Readers will learn the clinical context of the procedure, typical sites of service, and which major payers commonly adjudicate claims for this repair. The publication provides benchmarks and policy-relevant notes about coding capture, common modifier usage, and documentation elements payers often review. Where payer-specific policy details are not available in the input, the text notes: Data not available in the input.
Billing Code Overview
CPT code 65270 describes the surgical repair of a laceration of the conjunctiva, the transparent membrane covering the eye. The procedure brings wound edges together with direct suture closure and includes closure of any nonperforating scleral laceration present.
Service Type: Ophthalmic minor surgical repair of ocular surface laceration
Typical Site of Service: Ambulatory surgical center or hospital outpatient department; may also be performed in an emergency department when indicated.
Clinical & Coding Specifications
Clinical Context
A typical patient is an adult or child presenting to an emergency department, urgent care clinic, or ophthalmology clinic after sustaining blunt or sharp trauma to the eye with visible tearing of the conjunctiva and possibly a superficial scleral laceration. The triage nurse documents mechanism of injury, visual acuity, pain, and any foreign body sensation. A provider performs a focused eye exam including visual acuity, pupil reactivity, slit-lamp or bedside magnified inspection, and fluorescein staining to exclude full-thickness globe perforation. Imaging (orbital CT) is obtained if globe rupture or intraocular foreign body is suspected.
If the laceration is nonperforating and amenable to primary closure, the patient is consented for repair. Procedure typically occurs in a procedure room, minor surgery suite, or operating room depending on patient cooperation and associated injuries. Topical or local anesthesia with infiltration and/or monitored anesthesia care is used. The surgeon approximates conjunctival edges and places interrupted absorbable sutures; if a superficial scleral tear is present without perforation, it is closed directly. Post-procedure care includes topical antibiotic and steroid as indicated, tetanus status review, eye shield, return precautions for worsening vision or pain, and follow-up with ophthalmology within 24–72 hours.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
26 | Professional component | Use when billing separately for the physician’s professional portion if technical component billed by facility |