natashalage
Guru
Hello coding community 
I am new to eye surgeries for strabismus and your help will be greatly appreciated in defining 67334 CPT for my case below specifically for the LEFT eye. I know that 67334 and 67335 are add-on to 67311-67318. My puzzle is do we code +67334 for the LEFT eye based on this OP note? Would you say 67334 was performed bilaterally? Here is my rational:
1. 67334- Strabismus surgery by posterior fixation suture technique, with or without muscle recession.
2. An extract from Lay description: ‘During strabismus surgery, the extraocular muscle is isolated far posterior to its insertion. The borders or edges of the muscle are sutured to the eye far back of the insertion in what is commonly called the Faden procedure”
3. Me. I would code 67334 for the Right eye only and Not for the LEFT because the muscle of the left eye was re-attached to the ‘original insertion’ and not posteriorly, far back.
"..Next, attention was turned to the right eye. Using Westcott scissors and 0.2 forceps, a limbal incision was created temporally. Next, a small hook was used to isolate the lateral rectus muscle. This was replaced with a Green hook and the small hook was used to retract conjunctiva and Tenons capsule over the muscle. Next, blunt dissection was used to carefully dissect all the soft tissue attachments to the muscle including Tenons capsule and the intermuscular septum. Once the muscle was completely dissected, a 6-0 Vicryl suture on an S29 needle was used to secure the muscle at its insertion using a 3 point fixation technique. The muscle was then disinserted from the sclera and reattached 7 mm posterior to its original insertion. The Vicryl suture was secured to the sclera and tied. The position of the muscle was confirmed at the desired distance using calipers and the conjunctiva was then closed using interrupted 6-0 plain gut sutures.
Next attention was turned to the LEFT eye. Using Westcott scissors and 0.25 forceps, a limbal peritomy was created temporally. Next, a medium hook was used to isolate the lateral rectus muscle. This was replaced with a Green hook and small hooks was used to retract conjunctiva and Tenons capsule over the muscle. Next, blunt dissection was used to carefully dissect all the soft tissue attachments to the muscle including Tenons capsule and the intermuscular septum. Once the muscle was completely dissected, a 6-0 Vicryl suture on an S29 needle was used to secure the muscle at its insertion using a 3 point fixation technique. The muscle was then disinserted from the sclera and reattached at its original insertion. The Vicryl suture was secured with another vicryl suture using a sliding noose and both sutures were tied with an air knot. The muscle was allowed to hang back 7 mm. The position of the muscle was confirmed at the desired distance using calipers and the conjunctiva was closed using one permanent interrupted 6-0 plain gut suture inferiorly and one temporary superior suture that was left long and tied with an air knot to allow for adjustment. Healon was injected under the muscle to facilitate adjustment."
Thank you!
I am new to eye surgeries for strabismus and your help will be greatly appreciated in defining 67334 CPT for my case below specifically for the LEFT eye. I know that 67334 and 67335 are add-on to 67311-67318. My puzzle is do we code +67334 for the LEFT eye based on this OP note? Would you say 67334 was performed bilaterally? Here is my rational:
1. 67334- Strabismus surgery by posterior fixation suture technique, with or without muscle recession.
2. An extract from Lay description: ‘During strabismus surgery, the extraocular muscle is isolated far posterior to its insertion. The borders or edges of the muscle are sutured to the eye far back of the insertion in what is commonly called the Faden procedure”
3. Me. I would code 67334 for the Right eye only and Not for the LEFT because the muscle of the left eye was re-attached to the ‘original insertion’ and not posteriorly, far back.
"..Next, attention was turned to the right eye. Using Westcott scissors and 0.2 forceps, a limbal incision was created temporally. Next, a small hook was used to isolate the lateral rectus muscle. This was replaced with a Green hook and the small hook was used to retract conjunctiva and Tenons capsule over the muscle. Next, blunt dissection was used to carefully dissect all the soft tissue attachments to the muscle including Tenons capsule and the intermuscular septum. Once the muscle was completely dissected, a 6-0 Vicryl suture on an S29 needle was used to secure the muscle at its insertion using a 3 point fixation technique. The muscle was then disinserted from the sclera and reattached 7 mm posterior to its original insertion. The Vicryl suture was secured to the sclera and tied. The position of the muscle was confirmed at the desired distance using calipers and the conjunctiva was then closed using interrupted 6-0 plain gut sutures.
Next attention was turned to the LEFT eye. Using Westcott scissors and 0.25 forceps, a limbal peritomy was created temporally. Next, a medium hook was used to isolate the lateral rectus muscle. This was replaced with a Green hook and small hooks was used to retract conjunctiva and Tenons capsule over the muscle. Next, blunt dissection was used to carefully dissect all the soft tissue attachments to the muscle including Tenons capsule and the intermuscular septum. Once the muscle was completely dissected, a 6-0 Vicryl suture on an S29 needle was used to secure the muscle at its insertion using a 3 point fixation technique. The muscle was then disinserted from the sclera and reattached at its original insertion. The Vicryl suture was secured with another vicryl suture using a sliding noose and both sutures were tied with an air knot. The muscle was allowed to hang back 7 mm. The position of the muscle was confirmed at the desired distance using calipers and the conjunctiva was closed using one permanent interrupted 6-0 plain gut suture inferiorly and one temporary superior suture that was left long and tied with an air knot to allow for adjustment. Healon was injected under the muscle to facilitate adjustment."
Thank you!