My Peds Oph did an excision of a lesion on the conjunctiva. My thoughts are that since this is down to sclera 68130 is to be used, however this code does not include the repair that was required and also the isolation of the muscles. I'm thinking that a modifier 22 can be used for this. Any input on this would be greatly appreciated. Thanks so much!!
Here's the note:
A wire lid speculum was applied to the left eye and examination revealed a typical appearing lipodermoid in the superotemporal quadrant. A limbal conjunctival peritomy incision was created from 2 o'clock to 4 o'clock with careful dissection down to bare sclera. A muscle hook was passed under the superior rectus muscle followed by a pass of the Gass hook. A 5-0 silk suture was placed under the muscle and used to secure the superior rectus muscle. A small muscle hook was used to hook the lateral rectus muscle followed by several passes with the self-retaining muscle hook. With the muscle isolated, a 6-0 double-armed Vicryl suture was passed through the muscle belly at the insertion in the typical manner if this was a strabismus surgery. With both the superior and lateral rectus secured on sutures, careful dissection of the lesion was performed. It became evident that a large portion of the lesion had overlying conjunctiva that was unable to be resected from the lesion. Because of this, an inferior area of conjunctiva was careully dissected and loosened beneath the lesion to allow for conjunctival closure after resection of the lesion. The anterior portion of the lesion was carefully dissected to normal Tenon's capsule below and a large piece of the lesion was removed. The specimen was sent to pathology for evaluation. Bipolar caudery was performed for hemostasis to the remaining part of the lesion visible anteriorly. The conjunctival flaps were then closed with multiple interrupted 6-0 Plain gut sutures. Tobradex ointment was applied to the eye and the lid speculum was then removed.
Here's the note:
A wire lid speculum was applied to the left eye and examination revealed a typical appearing lipodermoid in the superotemporal quadrant. A limbal conjunctival peritomy incision was created from 2 o'clock to 4 o'clock with careful dissection down to bare sclera. A muscle hook was passed under the superior rectus muscle followed by a pass of the Gass hook. A 5-0 silk suture was placed under the muscle and used to secure the superior rectus muscle. A small muscle hook was used to hook the lateral rectus muscle followed by several passes with the self-retaining muscle hook. With the muscle isolated, a 6-0 double-armed Vicryl suture was passed through the muscle belly at the insertion in the typical manner if this was a strabismus surgery. With both the superior and lateral rectus secured on sutures, careful dissection of the lesion was performed. It became evident that a large portion of the lesion had overlying conjunctiva that was unable to be resected from the lesion. Because of this, an inferior area of conjunctiva was careully dissected and loosened beneath the lesion to allow for conjunctival closure after resection of the lesion. The anterior portion of the lesion was carefully dissected to normal Tenon's capsule below and a large piece of the lesion was removed. The specimen was sent to pathology for evaluation. Bipolar caudery was performed for hemostasis to the remaining part of the lesion visible anteriorly. The conjunctival flaps were then closed with multiple interrupted 6-0 Plain gut sutures. Tobradex ointment was applied to the eye and the lid speculum was then removed.