Ophthalmology and Optometry Coding Alert

Question: My ophthalmologist removed a 6.5-mm section of the lateral rectus muscle of a patient's left eye and resected the muscle to strengthen it and correct strabismus. He then repeated the procedure on the right eye, again removing 6.5 mm 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 code 67312 (Strabismus surgery, recession or resection procedure; two horizontal muscles) for resection of one horizontal muscle (lateral rectus). The CPT codes in the strabismus surgery section (67311-67318) refer to the number of muscles operated on in the same eye (unilateral service). When surgery on both eyes is performed on the same number of muscles, you may report the code with bilateral modifier 50 (Bilateral procedure).

Note: Some carriers still prefer reporting the code with modifier LT (Left side) and RT (Right side) as two separate line items on the CMS-1500 claim form. It is important to check with your local carrier for specific reporting instructions.

Why: The strabismus surgery codes (67311-67318) describe procedures done in one eye only. Even though the surgeon did resect two muscles, they were in different eyes, so 67312 is not correct.

Correct way: Instead you should report 67311 (Strabismus surgery, recession or resection procedure; one horizontal muscle) bilaterally. Most Medicare carriers want you to report the entire session on one line with modifier 50 and a "1" in the units field.