Summary & Overview
CPT 65290: Suture Repair of Ocular Muscle, Tendon, or Tenon’s Capsule
CPT code 65290 denotes surgical suturing of a wound to the muscle, tendon, and/or Tenon’s capsule of the eye. This ophthalmic soft-tissue repair is used when trauma or surgical complications produce defects in extraocular muscles or adjacent connective tissues that require operative closure. Nationally, accurate coding for this procedure affects clinical documentation, surgical scheduling, and claim adjudication for eye trauma and reconstructive ophthalmic cases.
Key payers relevant to this code include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise overview of the procedure’s clinical context and typical sites of service, plus what to expect in terms of coding classification and related administrative considerations.
This publication provides benchmarks and coding guidance context, highlights common billing considerations for ocular muscle and Tenon’s capsule repairs, and summarizes policy-relevant points that affect reimbursement and claims processing for this class of ophthalmic procedures. Data not available in the input.
Billing Code Overview
CPT code 65290 describes the suturing of a wound involving the muscle, tendon, and/or Tenon’s capsule of the eye. This service is an ocular soft-tissue repair procedure addressing structural damage to extraocular muscles or related connective tissue.
Service type: Surgical repair of ocular muscle/tendon/Tenon’s capsule
Typical site of service: Hospital operating room, ambulatory surgery center, or ophthalmic surgical suite
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Clinical & Coding Specifications
Clinical Context
A 42-year-old pedestrian presents to the ophthalmology ambulatory surgery unit after being struck by a bicycle, sustaining a full-thickness laceration to the right eye with involvement of extraocular muscle and Tenon’s capsule. The patient arrives from the emergency department; primary survey is complete and vision and globe integrity are assessed. The on-call ophthalmologist documents a penetrating eyelid and perilimbal conjunctival wound with incarceration of the superior rectus tendon and Tenon’s capsule. Under monitored anesthesia care in the ASC, the surgeon performs exploration, irrigation, debridement of devitalized tissue, and meticulous repair with absorbable sutures to the muscle and Tenon’s capsule, restoring alignment and closing conjunctiva. Postoperative orders include ophthalmic antibiotics, topical steroid taper, and scheduled follow-up within 24–72 hours for wound check and motility assessment.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
62 | Two surgeons | Use when two surgeons work together as primary surgeons on a complex ocular repair involving muscle or Tenon’s capsule. |
78 | Unplanned return to OR for related procedure following initial surgery |