How To Use CPT Code 65155

CPT 65155 describes the reinsertion of an ocular implant in the eye socket, using foreign material for reinforcement and/or attachment of muscles to the implant. This article will cover the description, procedure, qualifying circumstances, appropriate usage, documentation requirements, billing guidelines, historical information and billing examples.

1. What is CPT Code 65155?

CPT 65155 can be used to describe the reinsertion of an ocular implant in the eye socket, with the use of foreign material for reinforcement and/or attachment of muscles to the implant. This code is used when a provider opens the scleral shell, reinserts the implant, and uses suture or graft tissue to attach or reinforce the muscles. The conjunctival membrane is then closed over the implant.

2. Official Description

The official description of CPT code 65155 is: ‘Reinsertion of ocular implant; with use of foreign material for reinforcement and/or attachment of muscles to implant.’

3. Procedure

1. The provider prepares the patient and administers anesthesia.
2. The provider opens the scleral shell, which had been closed in a previous evisceration or enucleation procedure.
3. The provider reinserts the ocular implant into the eye socket.
4. The provider uses foreign material, such as suture or graft tissue, to reinforce the implant or attach the muscles.
5. The provider closes the conjunctival membrane over the implant.

4. Qualifying circumstances

CPT 65155 is performed when a patient requires the reinsertion of an ocular implant in the eye socket. This procedure is typically done after a previous evisceration or enucleation procedure. The use of foreign material, such as suture or graft tissue, is necessary to reinforce the implant or attach the muscles. The patient must meet the specific criteria for this procedure, as determined by the provider.

5. When to use CPT code 65155

CPT code 65155 should be used when a provider performs the reinsertion of an ocular implant in the eye socket, using foreign material for reinforcement and/or attachment of muscles to the implant. This code is specific to this procedure and should not be used for other ocular implant-related services.

6. Documentation requirements

To support a claim for CPT 65155, the provider must document the following information:

• Patient’s diagnosis and the need for reinsertion of the ocular implant
• Details of the procedure, including the use of foreign material for reinforcement and/or attachment of muscles to the implant
• Date of the procedure
• Any complications or additional procedures performed
• Signature of the provider performing the procedure

7. Billing guidelines

When billing for CPT 65155, ensure that the procedure meets the specific criteria outlined in the code description. Use the appropriate diagnosis codes to support medical necessity. It is important to note that CPT 65155 should not be reported with other codes unless specific circumstances warrant it. Review the documentation requirements and ensure all necessary information is included in the claim.

8. Historical information

CPT 65155 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 who previously underwent evisceration requires the reinsertion of an ocular implant. The provider uses suture material to reinforce the implant and attaches the muscles during the procedure.
2. After enucleation, a patient needs the ocular implant reinserted. The provider uses graft tissue to attach the muscles to the implant for better stability.
3. A patient with a history of ocular trauma undergoes the reinsertion of an ocular implant. The provider reinforces the implant with a combination of suture and graft material.
4. Following a previous ocular surgery, a patient requires the reinsertion of an ocular implant. The provider uses foreign material to attach the muscles to the implant, ensuring proper alignment and movement.
5. An individual who had an ocular implant removed due to complications now needs it reinserted. The provider reinforces the implant with suture material to prevent future issues.