2025 CPT code 65850
Effective Date: N/A Surgery - Surgical Procedures on the Eye and Ocular Adnexa Feed
Trabeculotomy ab externo.
Modifiers may be applicable to indicate specific circumstances, such as increased procedural services (22), bilateral procedures (50), or reduced services (52).
Medical necessity for trabeculotomy ab externo is established by documenting the presence of glaucoma, inadequate response to less invasive treatments like topical medications or laser procedures, and the clinical need to lower intraocular pressure to prevent further optic nerve damage and vision loss.
When the patient is appropriately prepped and anesthetized, the provider places a traction suture through the peripheral cornea, and creates a limbus-based conjunctival flap at the superior part of the globe. He then prepares a two-thirds partial thickness scleral flap. He incises the layer through the sclera directly anterior to the scleral spur with a blade and makes a small T-shaped cut into the roof of the Schlemm's canal. He advances a suture into the opening and flexes it first anteriorly and then posteriorly. He inserts a trabeculotome into the Schlemm's canal on one side and then rotates it into the anterior chamber. He repeats the same procedure again on the opposite side. He uses a rigid metal trabeculotome but may also use a Prolene® suture, securing the suture until he opens the angle. The provider may perform a second incision and use a scleral flap to retrieve the suture if it does not advance completely around the eye. He closes the flap, performs iridotomy, closes the conjunctiva, and injects subconjunctival antibiotics into the eye.
In simple words: This procedure improves fluid drainage in the eye to reduce pressure.The surgeon makes a small opening in the eye to access the drainage channels, then uses a special tool or suture to widen them. This helps the fluid flow out more easily.
The provider opens the trabecular meshwork to improve drainage of aqueous humor. When the patient is appropriately prepped and anesthetized, the provider places a traction suture through the peripheral cornea, and creates a limbus based conjunctival flap at the superior part of the globe. He then prepares a two thirds partial thickness scleral flap. He incises the layer through the sclera directly anterior to the scleral spur with a blade and makes a small T–shaped cut into the roof of the Schlemm's canal. He advances a suture into the opening and flexes it first anteriorly and then posteriorly. He inserts a trabeculotome into the Schlemm's canal on one side and then rotates it into the anterior chamber. He repeats the same procedure again on the opposite side. He uses a rigid metal trabeculotome but may also use a Prolene® suture, securing the suture until he opens the angle. The provider may perform a second incision and use scleral a flap to retrieve the suture if it does not advance completely around the eye. He closes the flap, performs iridotomy, closes the conjunctiva, and injects subconjunctival antibiotics into the eye.
Example 1: A 70-year-old patient with primary open-angle glaucoma uncontrolled by topical medications undergoes a trabeculotomy ab externo to improve aqueous humor outflow and reduce intraocular pressure., A 5-year-old child with congenital glaucoma requires a trabeculotomy ab externo due to developmental abnormalities affecting the trabecular meshwork., A 40-year-old patient with neovascular glaucoma secondary to diabetes undergoes a trabeculotomy ab externo to alleviate the elevated intraocular pressure caused by new blood vessel growth in the iris.
Documentation should include the diagnosis necessitating the procedure (e.g., glaucoma type), preoperative intraocular pressure measurements, description of the surgical technique, intraoperative findings, postoperative status, and any complications encountered.
- Revenue Code: P4E - EYE PROCEDURE - OTHER
- Specialties:Ophthalmology
- Place of Service:Ambulatory Surgical Center, Outpatient Hospital