How To Use CPT Code 65130

CPT 65130 describes the procedure for inserting an ocular implant in the scleral shell of an empty eye socket after evisceration. This article will cover the description, official description, procedure, qualifying circumstances, appropriate usage, documentation requirements, billing guidelines, historical information and billing examples.

1. What is CPT Code 65130?

CPT 65130 can be used to describe the procedure of inserting an ocular implant in the scleral shell of an empty eye socket. This code is used when the provider wraps the implant in the fibrous membrane called the sclera and places it deep into the socket. The implant is typically inserted several months after the evisceration procedure.

2. Official Description

The official description of CPT code 65130 is: ‘Insertion of ocular implant secondary; after evisceration, in scleral shell.’

3. Procedure

1. After appropriate preparation and anesthesia, the provider cleanses the empty eye socket and places a suture in the eyelid to hold it open.
2. The provider debrides the empty socket and irrigates it with an antibiotic solution to prevent infection.
3. Next, the provider prepares the ocular implant and wraps it in a scleral membrane.
4. The provider inserts the wrapped implant deep into the socket and sutures each of the rectus muscles to the implant sphere.
5. Finally, the provider closes Tenon’s capsule and the conjunctiva in separate layers over the implant and places an orbital conformer to preserve the shape of the eyelids.

4. Qualifying circumstances

CPT 65130 is performed when a patient requires an ocular implant to fill an empty eye socket after evisceration. The procedure involves wrapping the implant in the scleral shell, which is the thick fibrous outer covering of the eyeball. It is important to note that this code specifically applies to cases where the muscles are attached to the implant.

5. When to use CPT code 65130

CPT code 65130 should be used when the provider performs the insertion of an ocular implant in the scleral shell after evisceration, with the muscles attached to the implant. It is important to ensure that the procedure meets the specific criteria outlined in the code description.

6. Documentation requirements

To support a claim for CPT 65130, the provider must document the following information:

• Patient’s medical history and indication for the ocular implant
• Details of the procedure, including the date and duration
• Specific steps taken during the procedure, such as cleansing, debridement, and suturing
• Type of ocular implant used and its preparation
• Confirmation of the attachment of rectus muscles to the implant
• Closure of Tenon’s capsule and the conjunctiva
• Placement of the orbital conformer

7. Billing guidelines

When billing for CPT 65130, ensure that the procedure meets the specific criteria outlined in the code description. It is important to report this code only when the muscles are attached to the implant. Additionally, consider any applicable modifiers or additional codes that may be required for accurate billing.

8. Historical information

CPT 65130 was added to the Current Procedural Terminology system on January 1, 1990. There have been no updates or changes to the code since its addition.

9. Examples

1. A patient undergoes evisceration, and several months later, the provider performs the insertion of an ocular implant in the scleral shell with the muscles attached.
2. After evisceration, the provider wraps an ocular implant in the scleral shell and inserts it into the empty eye socket, ensuring that the muscles are attached to the implant.
3. A patient who previously had evisceration receives an ocular implant in the scleral shell, with the muscles attached, to restore the appearance of the eye socket.
4. Following evisceration, the provider performs the procedure of inserting an ocular implant in the scleral shell, ensuring that the muscles are attached for optimal function.
5. An individual who underwent evisceration undergoes the insertion of an ocular implant in the scleral shell, with the muscles attached, to improve the cosmetic appearance of the eye socket.
6. After evisceration, the provider wraps an ocular implant in the scleral shell and inserts it into the empty eye socket, ensuring that the muscles are attached to provide stability and movement.
7. A patient who had evisceration receives an ocular implant in the scleral shell, with the muscles attached, to restore the natural contour of the eye socket.
8. Following evisceration, the provider performs the procedure of inserting an ocular implant in the scleral shell, ensuring that the muscles are attached for proper alignment and movement.
9. An individual who underwent evisceration undergoes the insertion of an ocular implant in the scleral shell, with the muscles attached, to improve the overall function and appearance of the eye socket.
10. After evisceration, the provider wraps an ocular implant in the scleral shell and inserts it into the empty eye socket, ensuring that the muscles are attached to provide support and stability.