Summary & Overview
CPT 65280: Ocular Foreign Body Removal with Corneal or Scleral Repair
CPT code 65280 denotes removal of an ocular foreign body combined with repair of corneal or scleral injury. Nationally, this code captures acute ophthalmic interventions that address both penetrating or surface foreign bodies and related lacerations to the eye’s anterior structures. It is relevant to emergency medicine, ophthalmology, and ambulatory surgical practice given the potential for vision-threatening complications if not managed promptly.
Key payers covered in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise overview of clinical context for use of the code, typical sites of service (emergency department and outpatient surgical settings), and the types of services represented by the code. The publication summarizes common modifiers and coding considerations supplied in the source, highlights areas where policy updates or payer-specific rules commonly affect billing, and outlines the clinical scenarios that commonly lead to use of this code. Data not available in the input is clearly noted where applicable.
This summary is intended for coding professionals, revenue cycle staff, and clinical leaders seeking a focused reference to the code’s clinical meaning, common billing contexts, and payer landscape at a national level.
Billing Code Overview
CPT code 65280 describes a procedure in which the provider removes any foreign body present in the eye and repairs injuries to the cornea or sclera. The procedure typically involves both foreign body extraction and surgical repair of ocular surface lacerations.
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Service type: Ophthalmic surgical procedure involving removal of ocular foreign body and corneal or scleral repair
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Typical site of service: Emergency department or outpatient surgical setting, including ambulatory surgical centers
Clinical & Coding Specifications
Clinical Context
A 32-year-old construction worker presents to the emergency department after a high-velocity worksite accident with eye pain, tearing, and decreased vision in the right eye. On examination, a small metallic foreign body is visible on the corneal surface with associated corneal abrasion and localized stromal laceration. Topical anesthesia is applied, a slit-lamp exam and fluorescein staining are performed, and the provider removes the foreign body under magnification. The corneal laceration is irrigated, small epithelial defects are smoothed, and a single-layer repair with tissue adhesive or fine suturing is performed as indicated. Post-procedure care includes topical antibiotics, tetanus update if needed, pain control, and follow-up with an ophthalmologist within 24–48 hours.
Typical clinical workflow:
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Initial triage and visual acuity assessment
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Focused ocular exam with slit-lamp and fluorescein
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Topical anesthesia and foreign body removal at the slit lamp or minor procedure room
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Repair of corneal or scleral injury in the same encounter if indicated
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Documentation of laterality, procedural details, materials used, and post-procedure instructions
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Scheduling of ophthalmology follow-up and wound care instructions
Coding Specifications
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