Question: An ophthalmologist removed a 6.5-mm section of the lateral rectus muscle of a patient’s left eye. He resected the muscle to strengthen it and correct strabismus. He then repeated the procedure on the right eye, again removing 6.5mm of the lateral rectus muscle and then resecting it. Is 67312 the correct code to report because the ophthalmologist performed a resection procedure on two horizontal muscles?
Georgia Subscriber
Answer: You should not report 67312 (Strabismus surgery, recession or resection procedure; two horizontal muscles) for resection of one lateral rectus.
Why: The strabismus surgery codes (67311-67318) describe procedures done in one eye only (unilateral service). Although the surgeon did resect two muscles in this case, they were in different eyes -- therefore, 67312 is not correct.
Correct way: Instead, for a hospital outpatient, you should report 67311 (Strabismus surgery, recession or resection procedure; one horizontal muscle) with bilateral modifier 50 (Bilateral procedure). Most Medicare carriers want you to report the entire session on one line with modifier 50 and a "1" in the units’ field.
Note: Some carriers still prefer reporting the code with modifiers LT (Left side) and RT (Right side) as two separate line items on the claim form. Be sure to check with your local carrier for specific reporting instructions.
