CPT 65272 Conjunctival Laceration Reimbursement | OpenPayer

Summary & Overview

CPT 65272: Conjunctival Laceration Repair with Tissue Rearrangement

CPT code 65272 denotes surgical repair of a conjunctival laceration where wound edges are jagged and require tissue mobilization or rearrangement to close. This ophthalmic soft-tissue procedure is performed on an outpatient basis—commonly in ambulatory surgical centers, hospital outpatient departments, or office-based procedure suites—and is relevant to emergency, trauma, and ophthalmology surgical care nationally. The code matters because it captures a distinct level of complexity compared with simple conjunctival repairs and informs payment, quality measurement, and resource planning for eye trauma services.

Key payers covered in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find concise clinical context for when 65272 is reported, typical sites of service, and how the code is used to distinguish repairs requiring tissue rearrangement versus primary closure. The publication summarizes benchmarks and payment patterns where available, highlights policy considerations affecting outpatient ophthalmic procedural billing, and outlines operational implications for coding accuracy and documentation. Data not available in the input is noted where applicable.

AetnaBlue Cross Blue ShieldCigna HealthUnitedHealthcareMedicareCPT 65272conjunctival laceration repairophthalmologyeye traumasurgical procedureoutpatient surgeryambulatory surgical centercoding and billing

Billing Code Overview

CPT code 65272 describes repair of a conjunctival laceration with tissue mobilization or rearrangement. The procedure addresses a tear in the conjunctiva where wound edges are jagged and do not approximate directly, requiring surgical manipulation of surrounding tissues to achieve closure. The repair is typically performed on a single eye and does not require inpatient hospitalization.

Service type: Surgical ophthalmic procedure for soft tissue repair of the eye (conjunctiva)
Typical site of service: Ambulatory surgical center or hospital outpatient department; may also be performed in an ophthalmologist's office procedure suite depending on clinical judgment and facility capabilities.

Data not available in the input.

Clinical & Coding Specifications

Clinical Context

A 28-year-old patient presents to the ophthalmology clinic after sustaining a sharp-trauma to the right eye while gardening. The patient reports immediate tearing, foreign-body sensation, and visible blood on the white of the eye. On exam the provider identifies a jagged, full-thickness conjunctival laceration on the bulbar conjunctiva whose edges do not align and require tissue rearrangement to achieve a water-tight closure. Visual acuity is assessed and documented; topical anesthesia is administered in clinic, and the patient is prepped and draped. The provider performs an urgent repair of the conjunctival laceration using fine absorbable sutures with layered tissue approximation and hemostasis. The procedure is completed without need for hospitalization. Post-procedure, the patient receives ocular antibiotics, topical steroids as indicated, instructions for activity restriction, and a follow-up appointment within 24–72 hours for wound check and suture assessment. Billing uses 65272 for repair of a complex conjunctival laceration; documentation includes time, anesthesia, laterality, procedure details, consent, and post-op instructions for coding and billing verification.

Coding Specifications

Modifier	Description	When to Use
`-RT` / `-LT`	Right or Left side designator

CPT 65290: Suture Repair of Ocular Muscle, Tendon, or Tenon’s Capsule

CPT-65275-CORNEAL-LACERATION-REPAIR

CPT 65275: Corneal Laceration Repair

CPT-65286-CORNEAL-AND-SCLERAL-TISSUE-ADHESIVE-REPAIR

CPT 65286: Corneal and Scleral Repair Using Tissue Adhesive

CPT-65270-CONJUNCTIVAL-LACERATION-REPAIR

CPT 65270: Conjunctival Laceration Repair

CPT-65285-OCULAR-TRAUMA-GLOBE-REPAIR-CORNEA-SCLERA-UVEAL

CPT 65285: Repair of Corneal/Scleral Tear with Uveal Manipulation

CPT-65280-OCULAR-FOREIGN-BODY-REMOVAL-AND-CORNEAL-SCLERAL-REPAIR

CPT 65280: Ocular Foreign Body Removal with Corneal or Scleral Repair

CPT-65273-CONJUNCTIVAL-LACERATION-REPAIR-COMPLEX

CPT 65273: Complex Conjunctival Laceration Repair

Taxonomy Code	Specialty	Notes
`207W00000X`	Ophthalmology	Most common specialty performing `65272` for conjunctival laceration repair.
`207X00000X`	Optometry	May provide co-management and triage; surgical repair primarily by ophthalmologists.
`2086S0126X`	Emergency Medicine	Often performs initial assessment and stabilization before ophthalmology repair; may perform bedside repairs in some settings.
`2080S0006X`	General Surgery (Trauma)	In polytrauma cases where ophthalmology consult is unavailable, trauma surgeons may assist with ocular surface repairs.
`207L00000X`	Pediatric Ophthalmology	Performs repairs in pediatric patients or when specialized care is required.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`S05.01XA`	Injury of conjunctiva and corneal abrasion without foreign body, right eye, initial encounter	Common diagnosis when a conjunctival laceration is present on the right and initial repair is performed.
`S05.02XA`	Injury of conjunctiva and corneal abrasion without foreign body, left eye, initial encounter	Same as above for the left eye.
`S05.11XA`	Penetrating wound of conjunctiva, right eye, initial encounter	Used when laceration is penetrating or more severe involving deeper conjunctival tissue.
`S05.12XA`	Penetrating wound of conjunctiva, left eye, initial encounter	Left-eye equivalent.
`H11.00`	Conjunctival hemorrhage, unspecified	May be documented with conjunctival laceration when bleeding of the conjunctiva is present.
`T15.02XA`	Foreign body in cornea and conjunctiva, left eye, initial encounter	Used when a retained foreign body is involved requiring removal during repair.
`S05.9XXA`	Unspecified injury of eye and orbit, initial encounter	Use when specific conjunctival diagnosis is not yet determined but repair is performed urgently.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`65222`	Repair of superficial punctate conjunctival laceration (simple)	Used for small conjunctival lacerations that approximate without tissue rearrangement; choose `65222` when edges come together directly rather than `65272`.
`65435`	Removal of foreign body, external eye; conjunctival	Performed when an intra-conjunctival foreign body is present and removed either before or during laceration repair.
`99100`	Anesthesia for patient of extreme age, pediatric or geriatric, in addition to other services	May be reported when additional anesthesia management is required for high-risk patients (use payer rules).
`10060`	Incision and drainage of abscess (soft tissue) — example of unrelated soft tissue code	Not typical for conjunctival repair but may be billed for concurrent periorbital soft tissue procedures if clinically performed (use appropriate ophthalmic codes first).
`92002`	Ophthalmological services: intermediate, new patient, established patient (office or other outpatient)	Pre- and post-procedure ophthalmologic evaluations are often billed separately if documentation supports separate evaluation and management services.

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