2025 CPT code 65810
Effective Date: N/A Surgery - Surgical Procedures on the Eye and Ocular Adnexa Feed
Paracentesis of anterior chamber of eye (separate procedure); with removal of vitreous and/or discission of anterior hyaloid membrane, with or without air injection.
Modifiers, such as -50 (Bilateral Procedure), -78 (Unplanned Return to the Operating/Procedure Room), and others, may be applicable depending on the circumstances. Refer to current CPT guidelines for proper modifier usage.
Medical necessity for this procedure is established by demonstrating that the patient has a condition, such as central retinal artery occlusion or elevated intraocular pressure, that requires immediate intervention to preserve vision or prevent further eye damage. The documentation should clearly link the procedure to the diagnosis and explain why less invasive treatments are not appropriate.
The ophthalmologist performs the procedure after the patient is prepped and anesthetized. This involves using an eyelid speculum, inserting a needle to withdraw vitreous, potentially dissecting the anterior hyaloid membrane, and injecting air.
In simple words: This procedure drains fluid and removes some of the gel-like substance from the front part of your eye. The doctor might also cut a membrane in your eye and inject air to help maintain the eye's shape. It’s usually done when a blockage in an artery in your eye is threatening your vision.
This procedure involves draining fluid from the anterior chamber of the eye and removing vitreous. It may also include dissecting the anterior hyaloid membrane, and injecting air into the eye. This is typically done to relieve pressure caused by a blockage in the central retinal artery. The procedure starts with prepping and anesthetizing the patient. An eyelid speculum is used to hold the eye open. A needle attached to a syringe is inserted into the anterior chamber to withdraw vitreous. Part of the hyaloid membrane, which separates the vitreous humor from the rest of the eye, may be destroyed. This reduces intraocular pressure, unblocks the central retinal artery, and reduces potential retinal damage. Air may be injected to maintain consistent intraocular pressure.
Example 1: A patient presents with central retinal artery occlusion and elevated intraocular pressure. The ophthalmologist performs a paracentesis of the anterior chamber with removal of vitreous and discission of the anterior hyaloid membrane to alleviate the pressure and restore blood flow., A patient with a recent eye surgery develops ocular hypertension. To reduce the pressure and prevent damage to the optic nerve, the ophthalmologist performs repeated paracentesis of the anterior chamber with vitreous removal., Following trauma to the eye, a patient develops vitreous hemorrhage and elevated intraocular pressure. The physician performs a paracentesis of the anterior chamber, removing vitreous and blood to improve vision and reduce the risk of further complications.
Documentation should include the reason for the procedure (e.g., central retinal artery occlusion, ocular hypertension), details of the procedure performed (including whether discission of the anterior hyaloid membrane and air injection were performed), and the amount of vitreous removed. Pre- and post-procedure intraocular pressure measurements should also be recorded. Any complications encountered during or after the procedure should be documented as well.
- Global Days: 90 days
- Specialties:Ophthalmology
- Place of Service:Ambulatory Surgical Center, Hospital Inpatient, Hospital Outpatient, Physician's Office