Ophthalmology and Optometry Coding Alert

Translating the ophthalmologist's documentation into procedure codes is often the hardest part of coding strabismus operations. Easily identify the correct codes for your next strabismus surgery claim using these quick questions. Which muscles were operated on? To answer this question, a little anatomy will take you a long way.

"Without doubt, the more any coder knows about anatomy, the better," says Linda Abel, CPC, assistant administrator with Hauser-Ross Eye Institute in Sycamore, Ill. "However, when coding strabismus procedures, a few basic definitions and a good understanding of the rules will carry you a long way."

Mary Schwall, CPC, clinical practice specialist for the Yale School of Medicine in Connecticut, proffers a quick reference for ramping up on the extraocular anatomy: "Use the pictures in your CPT book as a guide," she suggests.

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.

The eye's two horizontal muscles are the lateral and medial rectus muscles; the vertical muscles consist of the superior and inferior rectus muscles; and the fifth and sixth muscles, the superior and inferior oblique muscles, are wrapped around the eye from top to bottom. Strabismus surgery involves the recession the weakening of extraocular muscle(s) or resection the strengthening of extraocular muscle(s). If you know whether the muscles operated on are horizontal, vertical or oblique, you know which CPT codes you should access to report your surgical procedures 67311-67318.

"It's not so much the muscle itself, but the muscle group (i.e., horizontal, vertical and oblique)," Schwall says. If you are lucky, your physician will clearly indicate which types of muscles were involved in the surgery, she adds. If not, Abel suggests coders "sit down with the doctor and gain a basic understanding of the muscles of the eye, connecting name and function."

For horizontal muscles, only codes 67311 and 67312 apply. 67314 and 67316 apply to surgery on the vertical muscles. And if the oblique muscles are operated on, you must identify them with procedure code 67318. How many muscles were operated on in each eye? The horizontal and vertical muscle codes are broken down depending on the number of muscles altered and by eye don't be surprised when your ophthalmologist reports operating on four muscles in one session! Suppose a patient presents with esotropia, or turning in, of the left eye. The ophthalmologist resects the medial rectus muscle in the patient's left eye to correct the alignment. You would report 67311 (Strabismus surgery, recession or resection procedure; one horizontal muscle) to specify that one horizontal muscle was operated on in one eye. [...]