Summary & Overview
CPT 65810: Anterior Chamber Drainage with Vitreous Removal
CPT code 65810 identifies an ophthalmic surgical procedure that combines drainage of the anterior chamber with removal of vitreous and may include dissection of the anterior hyaloid membrane. This intervention is used in acute, vision-threatening situations such as central retinal artery occlusion where rapid surgical management can affect visual outcomes. Nationally, the code is significant for coverage decisions, facility resource planning, and clinical pathway development for emergent retinal and ocular ischemic conditions.
Key payers in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. The publication summarizes payer coverage patterns, commonly applied modifiers, and clinical context for use of the code. Readers will find a concise clinical description, typical sites of service, and a synthesis of issues that affect billing and authorization for this procedure.
This overview clarifies what CPT code 65810 represents, outlines the clinical scenarios prompting the procedure, and summarizes the practical questions payers and providers encounter—such as documentation expectations, site-of-service considerations, and implications for emergent ophthalmic care. Data not available in the input is noted where applicable.
Billing Code Overview
CPT code 65810 describes a surgical procedure that drains fluid from the anterior chamber of the eye and removes vitreous. The procedure may include dissection of the anterior hyaloid membrane, with or without air injection. It is typically performed when the central retinal artery is blocked, a condition that can cause permanent vision loss or blindness.
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Service type: Ophthalmic surgical procedure involving anterior chamber paracentesis and limited vitrectomy with possible anterior hyaloid membrane dissection
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Typical site of service: Hospital operating room or ambulatory surgery center
Clinical & Coding Specifications
Clinical Context
A 68-year-old male presents to the emergency ophthalmology service with sudden, profound loss of vision in his right eye and severe ocular pain. On examination the pupil is nonreactive, intraocular pressure is elevated, and fundus exam is limited by media opacity; fluorescein angiography and ocular ultrasound suggest central retinal artery occlusion with concurrent anterior chamber hemorrhage and vitreous prolapse. The on-call retina surgeon and anesthesia team evaluate the patient rapidly. After informed consent, the patient is taken to an operating room or an ophthalmic procedure suite equipped for intraocular surgery. Under monitored anesthesia care or general anesthesia, the surgeon performs an anterior chamber paracentesis combined with anterior vitrectomy and removal/dissection of anterior hyaloid membrane, with possible intracameral air injection to restore anterior chamber anatomy and reduce intraocular pressure. Post-procedure, the patient is observed in a post-anesthesia care area, receives topical and systemic medications as indicated, and has scheduled retinal and intraocular pressure follow-up within 24–72 hours. The typical site of service is an outpatient ambulatory surgery center or hospital operating room staffed for ophthalmic microsurgery.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
22 | Increased procedural services | Use when the complexity or time of the procedure substantially exceeds typical; document justification. |