Ophthalmology and Optometry Coding Alert
Count One Eye for Each Strabismus Code
Question: Our surgeon performed a resection procedure on two horizontal muscles for strabismus. We reported 67312 (Strabismus surgery, recession or resection procedure; 2 horizontal muscles) but our auditor said this is wrong. Can you advise? Kentucky Subscriber Answer: During strabismus surgery, the surgeon shortens or lengthens the muscles surrounding the eye, which changes the alignment of one or both eyes. Confusion sometimes arises when the ophthalmic surgeon resects the lateral rectus muscles of both the patient’s eyes. Because the ophthalmologist in this case performed a resection procedure on two horizontal muscles, 67312 may look correct, but don’t fall into this trap. The strabismus surgery codes (67311-67318) describe unilateral procedures or procedures performed on one eye only. Although the surgeon did resect two muscles, they were in different eyes, so 67312 is not correct. Instead, you should report 67311 (Strabismus surgery, recession or resection procedure; 1 horizontal muscle) bilaterally. Most Medicare carriers want you to report the entire session on one line with modifier 50 (Bilateral procedure) and a “1” in the units field.
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