Outpatient Facility Coding Alert
Consider this Strabismus Scenario
Question: The surgeon performed a resection procedure on two horizontal muscles for strabismus. We reported 67312, but our claim was denied. Can you help us? Colorado Subscriber Answer: In strabismus surgery, the ophthalmic 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 (Strabismus surgery, recession or resection procedure; 2 horizontal muscles) may seem correct, but it is not. 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, you should report 67311 (Strabismus surgery, recession or resection procedure; 1 horizontal muscle) bilaterally. Most Medicare carrierswant you to report the entire session on one linewith modifier 50 (Bilateral procedure) and a "1" inthe units field.
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