Coding Ahead
CasePilot
Medical Coding Assistant
Case2Code
Search and Code Lookup Tool
CareerCenter
Medical Coding Job Board
Log in Register free account

Need help choosing the right code?

Ask CasePilot about procedures, modifiers, bundling, and coding guidance.

Try CasePilot

Official Description

Repair of wound, extraocular muscle, tendon and/or Tenon's capsule

© Copyright 2026 American Medical Association. All rights reserved.

Common Language Description

The procedure described by CPT® Code 65290 involves the repair of a wound affecting the extraocular muscle, tendon, and/or Tenon's capsule. This surgical intervention is performed using conventional sutures to restore the integrity of the affected structures. The eye is meticulously examined, often utilizing a slit lamp or operating microscope, to assess the extent of the wound and any potential damage to surrounding ocular structures. The eyeball is supported within the orbit and is encased by Tenon's capsule, a fibrous tissue that extends from the optic nerve entrance to the corneal limbus, firmly attaching to the conjunctiva. The extraocular muscles, which include the horizontal rectus, vertical rectus, and oblique muscles, are connected to the sclera (the white part of the eye) via broad, thin tendons. A wound on the cornea or sclera can compromise the structural integrity of these muscles, tendons, and Tenon's capsule. During the procedure, the surgeon identifies the ends of any transected muscle or tendon, reapproximates them, and secures them with sutures. Additionally, Tenon's capsule is carefully dissected to remove any foreign bodies or trapped tissue, which is then closed with sutures. At the conclusion of the surgery, antibiotics may be administered directly into the conjunctiva or other areas of the eye, and the eye is protected with a sterile dressing and an eye shield to promote healing and prevent infection.

© Copyright 2026 Coding Ahead. All rights reserved.

1. Indications

The repair of a wound to the extraocular muscle, tendon, and/or Tenon's capsule is indicated in the following situations:

  • Trauma to the Eye: This procedure is often performed in cases of traumatic injury to the eye that results in lacerations or wounds affecting the extraocular muscles or associated structures.
  • Disruption of Muscle Integrity: Indications include any condition where the integrity of the extraocular muscles or tendons is compromised, leading to potential functional impairment of eye movement.
  • Foreign Body Presence: The presence of foreign bodies within the eye that may cause damage to the extraocular muscles or Tenon's capsule necessitates surgical intervention for removal and repair.

2. Procedure

The procedure for repairing a wound to the extraocular muscle, tendon, and/or Tenon's capsule involves several critical steps:

  • Step 1: The surgical site is prepared, and the patient is positioned appropriately to allow for optimal access to the eye. Anesthesia is administered to ensure patient comfort during the procedure.
  • Step 2: A thorough examination of the eye is conducted using a slit lamp or operating microscope. This examination is crucial for assessing the extent of the wound and any damage to the surrounding ocular structures.
  • Step 3: The surgeon identifies the transected ends of the extraocular muscle or tendon. These ends are carefully reapproximated to restore continuity and function.
  • Step 4: Sutures are used to secure the reapproximated muscle or tendon ends. The choice of suture material and technique is critical to ensure proper healing and minimize complications.
  • Step 5: If Tenon's capsule is involved, it is meticulously dissected to expose any foreign bodies or trapped tissue. This step is essential for preventing infection and ensuring complete repair.
  • Step 6: After addressing any foreign bodies, Tenon's capsule is closed with sutures to restore its integrity and support the healing process.
  • Step 7: At the conclusion of the procedure, antibiotics may be injected into the conjunctiva or other areas of the eye to prevent infection. The eye is then covered with a sterile dressing and an eye shield to protect it during the initial recovery phase.

3. Post-Procedure

Post-procedure care involves monitoring the patient for any signs of complications, such as infection or improper healing. The patient may be advised to keep the eye covered with a sterile dressing and eye shield for a specified period to protect the surgical site. Follow-up appointments are essential to assess healing and ensure that the extraocular muscles are functioning properly. Patients may also receive instructions regarding the use of prescribed medications, including antibiotics or anti-inflammatory agents, to support recovery and manage any discomfort.

Short Descr REPAIR OF EYE SOCKET WOUND
Medium Descr RPR WND EXTRAOCULAR MUSCLE TENDON&/TENON CAPSU
Long Descr Repair of wound, extraocular muscle, tendon and/or Tenon's capsule
Status Code Active Code
Global Days 090 - Major Surgery
PC/TC Indicator (26, TC) 0 - Physician Service Code
Multiple Procedures (51) 2 - Standard payment adjustment rules for multiple procedures apply.
Bilateral Surgery (50) 1 - 150% payment adjustment for bilateral procedures applies.
Physician Supervisions 09 - Concept does not apply.
Assistant Surgeon (80, 82) 1 - Statutory payment restriction for assistants at surgery applies to this procedure...
Co-Surgeons (62) 1 - Co-surgeons could be paid, though supporting documentation is required...
Team Surgery (66) 0 - Team surgeons not permitted for this procedure.
Diagnostic Imaging Family 99 - Concept Does Not Apply
APC Status Indicator Hospital Part B services paid through a comprehensive APC
ASC Payment Indicator Surgical procedure on ASC list in CY 2007; payment based on OPPS relative payment weight.
Type of Service (TOS) 2 - Surgery
Berenson-Eggers TOS (BETOS) P4E - Eye procedure - other
MUE 1
CCS Clinical Classification 21 - Other extraocular muscle and orbit therapeutic procedures
50 Bilateral procedure: unless otherwise identified in the listings, bilateral procedures that are performed at the same session, should be identified by adding modifier 50 to the appropriate 5 digit code. note: this modifier should not be appended to designated "add-on" codes (see appendix d).
51 Multiple procedures: when multiple procedures, other than e/m services, physical medicine and rehabilitation services or provision of supplies (eg, vaccines), are performed at the same session by the same individual, the primary procedure or service may be reported as listed. the additional procedure(s) or service(s) may be identified by appending modifier 51 to the additional procedure or service code(s). note: this modifier should not be appended to designated "add-on" codes (see appendix d).
58 Staged or related procedure or service by the same physician or other qualified health care professional during the postoperative period: it may be necessary to indicate that the performance of a procedure or service during the postoperative period was: (a) planned or anticipated (staged); (b) more extensive than the original procedure; or (c) for therapy following a surgical procedure. this circumstance may be reported by adding modifier 58 to the staged or related procedure. note: for treatment of a problem that requires a return to the operating/procedure room (eg, unanticipated clinical condition), see modifier 78.
78 Unplanned return to the operating/procedure room by the same physician or other qualified health care professional following initial procedure for a related procedure during the postoperative period: it may be necessary to indicate that another procedure was performed during the postoperative period of the initial procedure (unplanned procedure following initial procedure). when this procedure is related to the first, and requires the use of an operating/procedure room, it may be reported by adding modifier 78 to the related procedure. (for repeat procedures, see modifier 76.)
79 Unrelated procedure or service by the same physician or other qualified health care professional during the postoperative period: the individual may need to indicate that the performance of a procedure or service during the postoperative period was unrelated to the original procedure. this circumstance may be reported by using modifier 79. (for repeat procedures on the same day, see modifier 76.)
E2 Lower left, eyelid
E3 Upper right, eyelid
GC This service has been performed in part by a resident under the direction of a teaching physician
LT Left side (used to identify procedures performed on the left side of the body)
RT Right side (used to identify procedures performed on the right side of the body)
SG Ambulatory surgical center (asc) facility service
Date
Action
Notes
2013-01-01 Changed Medium Descriptor changed.
Pre-1990 Added Code added.
Code
Description
Code
Description
Code
Description
Code
Description
Code
Description
CasePilot

Get instant expert-level medical coding assistance.

Ask about:
CPT Codes Guidelines Modifiers Crosswalks NCCI Edits Compliance Medicare Coverage
Example: "What is CPT code 99213?" or "Guidelines for E/M services"