2025 CPT code 65175
(Active) Effective Date: N/A Revision Date: N/A Deletion Date: N/A Surgery - Surgical Procedures on the Eye and Ocular Adnexa Surgery Feed
Removal of an ocular implant located within the eye's muscular cone.
Modifiers may be applicable based on the specific circumstances of the procedure.Examples include -22 (Increased Procedural Services), -52 (Reduced Services), -53 (Discontinued Procedure), -54 (Surgical Care Only), -55 (Postoperative Management Only), -56 (Preoperative Management Only), -58 (Staged or Related Procedure), and others.
Medical necessity for removal of an ocular implant is established by the presence of infection, implant extrusion/exposure, recurrent inflammation, pain, visual impairment, or any other significant complication that necessitates intervention.Documentation must clearly support the need for removal to ensure appropriate reimbursement.
The ophthalmologist or qualified surgeon is responsible for performing the surgical procedure.This includes preoperative assessment, patient preparation and anesthesia, surgical removal of the implant, and postoperative care.
In simple words: The doctor removes an artificial eye from inside the eye socket. This is done carefully to avoid damaging surrounding tissues.The artificial eye is usually not replaced at the same time.
This procedure involves the surgical removal of an ocular implant (artificial eye) situated within the muscular cone of the extraocular muscles of the eye.The surgeon carefully removes the implant, excising any attachments to extraocular muscles while avoiding damage to surrounding tissues.Preoperative preparation and anesthesia are administered.Conjunctival tissue and Tenon's capsule may be excised and retracted to access the implant. Replacement of the implant is typically not performed during the same procedure.
Example 1: A patient presents with an infected ocular implant that is causing discomfort and vision impairment.The surgeon performs a removal of the implant under general anesthesia to resolve the infection., A patient's ocular implant has become dislodged and requires removal due to significant discomfort and potential damage to the surrounding structures.The surgeon meticulously removes the implant to prevent further damage., A patient experiences recurrent exposure of an ocular implant, with signs of inflammation.Surgical removal of the implant is deemed necessary to address the ongoing issue and prevent further complications.
Complete medical history, including details about the original implant surgery and any subsequent complications.Preoperative and postoperative notes, including assessment of infection (if present).Surgical report detailing the procedure performed, including any complications encountered and the condition of the surrounding tissues.Imaging studies (e.g., photographs, OCT scans) before and after the procedure.
** Always ensure that documentation accurately reflects the procedure performed and supports medical necessity.When in doubt, consult with a coding specialist or refer to the AMA CPT manual for detailed coding guidelines.
- Revenue Code: P4E (EYE PROCEDURE - OTHER)
- RVU: The relative value units (RVUs) for CPT code 65175 vary based on geographic location, payer, and other factors.Consult your local Medicare Administrative Contractor (MAC) for specific reimbursement information.
- Global Days: The global period for this procedure is not specified in the provided data.The global period will vary based on payer and other factors.Check your payer's specific guidelines for details.
- Payment Status: Active
- Modifier TC rule: The application of a Technical Component (TC) modifier is not typically applicable to CPT code 65175 as it is usually considered a professional service.
- Fee Schedule: Historical fee schedule data is not available in the provided source.Consult your local payer for historical fee schedule information.
- Specialties:Ophthalmology
- Place of Service:Ambulatory Surgical Center, Hospital Outpatient, Office