Ophthalmology and Optometry Coding Alert

Question: When filing for strabismus surgery, what is the proper way to code when the procedure is done on both eyes? Should we use modifier -50? One or two units?

Anonymous Michigan Subscriber

Answer: The proper way to code for strabismus surgery done on both eyes for most Medicare carriers is to bill the procedure code, the modifier -50 (bilateral procedure), and a 1 in the units field.

For example, the ophthalmologist performs strabismus surgery on two horizontal muscles one in the left eye and one in the right eye. There is a common billing error made with this scenario, and that is to bill 67312. Here is the difference: 67311 is for strabismus surgery, recession or resection procedure; one horizontal muscle, while 67312 is for strabismus surgery, recession or resection procedure; two horizontal muscles. Billers who use 67312 when the doctor has done the procedure in two eyes are making an understandable error: CPT does say two muscles. Each strabismus code, however, is per eye only.

You cant add up the muscles done in two eyes and use a code that is meant for one eye. If you do, you are inaccurately representing the work that was done, and you are also losing reimbursement. If the physician performs strabismus surgery on two horizontal muscles in the left eye and one horizontal in the right eye, you would not use the -50 modifier. Instead, you would put 67312-LT on the first line and 67311-RT on the second line.

Tip: Always put the more costly procedure on the first line because Medicare will reduce the second surgical procedure by 50 percent.

Coding for strabismus surgery done in both eyes is different for each payer. Although most Medicare carriers want one line with the -50 modifier and one unit in the units field, Medicaid often prefers two lines with a -50 modifier on the second line. Managed care plans vary in terms of their requirementsyou need to find out how they want it to be filed. And indemnity plansthe few that are leftare most often requesting eye modifiers (so that you would use 67311-LT on the first line and 67311-RT on the second line).

Sources for answers to Reader Questions: Raequell Duran, president, Practice Solutions (Calif.); and Lise Roberts, vice president, Health Care Compliance Strategies (N.Y.).