How To Use CPT Code 65235

CPT 65235 describes the procedure for the removal of a foreign body from within the eye, specifically from the anterior chamber or lens. This article will provide an overview of CPT code 65235, including its official description, the procedure itself, qualifying circumstances, appropriate usage, documentation requirements, billing guidelines, historical information and billing examples.

1. What is CPT Code 65235?

CPT 65235 is used to describe the removal of a foreign body from within the eye, specifically from the anterior chamber or lens. This procedure is performed by a healthcare provider after the patient has been appropriately prepped and anesthetized. The provider examines the anterior chamber and retina to identify the location of the foreign body. Forceps are then used to grasp and remove the foreign object from the eye. The provider carefully examines the area and closes the injury site with sutures if necessary.

2. Official Description

The official description of CPT code 65235 is: ‘Removal of foreign body, intraocular; from anterior chamber of eye or lens.’ It is important to note that for the removal of implanted material from the anterior segment, a different code, 65920, should be used.

3. Procedure

1. After appropriate prepping and anesthesia, the healthcare provider examines the anterior chamber and retina of the eye.
2. The provider identifies the location of the intraocular foreign body.
3. Using forceps, the provider carefully grasps and removes the foreign object from the eye.
4. The area is thoroughly examined to ensure no fragments or debris remain.
5. If necessary, the provider closes the injury site with sutures.

4. Qualifying circumstances

CPT 65235 is performed in cases where there is a foreign body within the eye that needs to be removed. This foreign body can originate from outside the body or may be displaced from another location within the body. The procedure specifically targets foreign bodies in the anterior chamber or lens of the eye. It is important to note that for the removal of implanted material from the anterior segment, a different code, 65920, should be used.

5. When to use CPT code 65235

CPT code 65235 should be used when a healthcare provider performs the procedure to remove a foreign body from the anterior chamber or lens of the eye. It is important to ensure that the foreign body is located within these specific areas before using this code. If the foreign body is located in a different part of the eye, a different code should be used.

6. Documentation requirements

To support a claim for CPT 65235, the healthcare provider must document the following information:

• Description of the foreign body and its location within the eye
• Details of the procedure, including any complications or additional steps taken
• Date and time of the procedure
• Any additional services provided during the same encounter
• Signature of the healthcare provider performing the procedure

7. Billing guidelines

When billing for CPT 65235, it is important to ensure that the procedure was performed to remove a foreign body from the anterior chamber or lens of the eye. This code should not be reported if the foreign body was located in a different part of the eye. It is also important to follow any specific billing guidelines provided by insurance carriers or payers. Additionally, it is important to note that Medicare and some other carriers do not reimburse for emergency or after-hours services (such as 99058), so it is important to check with individual carriers for their specific reimbursement policies.

8. Historical information

CPT code 65235 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 presents with a metal shard in their anterior chamber, and the healthcare provider performs CPT 65235 to remove the foreign body.
2. During an examination, a healthcare provider discovers a small piece of glass lodged in a patient’s lens. CPT 65235 is used to remove the foreign body.
3. A patient reports discomfort and blurry vision after a workplace accident involving wood fragments. The healthcare provider performs CPT 65235 to remove the foreign bodies from the anterior chamber.
4. After a motor vehicle accident, a patient presents with a bone fragment in their lens. CPT 65235 is used to remove the foreign body.
5. A child accidentally gets sand in their eye, and the healthcare provider uses CPT 65235 to remove the foreign particles from the anterior chamber.
6. A patient presents with a metal splinter in their lens, and CPT 65235 is performed to remove the foreign body.
7. During an examination, a healthcare provider discovers a small insect trapped in a patient’s anterior chamber. CPT 65235 is used to remove the foreign body.
8. A patient reports a feeling of something in their eye after a gardening accident involving dirt. The healthcare provider performs CPT 65235 to remove the foreign particles from the anterior chamber.
9. After a workplace incident involving chemicals, a patient presents with a chemical particle in their lens. CPT 65235 is used to remove the foreign body.
10. A patient accidentally gets a small piece of plastic in their eye, and the healthcare provider uses CPT 65235 to remove the foreign body from the anterior chamber.