Nail Strabismus Surgery Coding Every Time With Foolproof Anatomy Knowledge
Published on Tue Jan 03, 2006
How many muscles? Horizontal or vertical? The answers will keep your coding from getting crossed up
When an ophthalmologist performs strabismus surgery, it can involve any combination of 12 extraocular muscles. Incorrectly identifying just one of those muscles can lead you to the wrong code--and take more than $700 in reimbursement out of your practice's pocket.
But you don't need a PhD in anatomy to keep the eye mucles straight--all you need are the answers to these frequently asked questions to guide you toward choosing the right code to report your practice's strabismus treatments. Question 1: How do I pick the appropriate strabismus surgery code based on the ophthalmologist's operative notes? Answer: A little knowledge of the eye's anatomy goes a long way toward understanding strabismus-correcting procedures. Which codes you report depends on the extraocular muscle or muscles the ophthalmologist operated on.
Each eye has six extraocular muscles that control the eyeball's movement and determine the eyeball's alignment, or in some cases misalignment. Strabismus surgery is the correction of misalignment with the potential restoration of quality visual activity.
CPT distinguishes the strabismus surgery codes (67311-67318) by whether the procedure involves horizontal, vertical or superior oblique muscles, says Nancy Cockrell, CPC, insurance manager at Jackson Eye Associates in Jackson, Miss.
Horizontal: The eye's two horizontal muscles are the lateral rectus (LR) and medial rectus (MR) muscles. (The MR muscle in either eye is the one closest to the nose.) If the ophthalmologist recesses (weakens) or resects (strengthens) these muscles, report 67311 (Strabismus surgery, recession or resection procedure; one horizontal muscle) or 67312 (... two horizontal muscles), depending on the number of muscles.
Vertical: The vertical muscles are the superior rectus (SR) and inferior rectus (IR) muscles. (The SR muscle is closer to the top of the head.) If the ophthalmologist recesses or resects these muscles, report 67314 (...one vertical muscle [excluding superior oblique]) or 67316 (...two or more vertical muscles [excluding superior oblique]), depending on the number of muscles.
CPT also considers the inferior oblique (IO) muscle--but not the superior oblique (SO) muscle--a vertical muscle, says Christina Hollis, OCS, coder and surgery scheduler at Pediatric Ophthalmology Associates in Columbus, Ohio. Report 67314-67316 for recession or resection of the inferior oblique muscles.
Superior oblique: The SO muscle wraps around the top of the eyeball. Report 67318 (Strabismus surgery, any procedure, superior oblique muscle) for procedures performed on the SO muscle. Question 2: Is strabismus surgery considered unilateral or bilateral? Answer: The strabismus surgery codes (67311-67318) are inherently unilateral, describing procedures performed in one eye only. When codes mention more than one muscle (e.g., 67312, Strabismus surgery, recession or resection procedures; two horizontal muscles), CPT is implying that those muscles are in the same eye, Cockrell says. Therefore, if [...]
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