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When an ophthalmologist carries out strabismus surgery, it
can include any combination of 12 extraocular muscles. Inaccurately identifying
just one of those muscles can lead you to the incorrect code -- and miss more
than $700 in reimbursement. Read this article to pin down precise CPT codes for
error-free medical coding.
However you don't require being an expert in anatomy to get
the eye muscles straight -- all you require are the answers to the following
listed frequently asked questions to guide you toward selecting the right code
to report your practice's strabismus treatments.
Question 1: How do you select the correct 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 CPT codes you
report rests on the definite extraocular muscle or muscles the ophthalmologist
operated on.
Each eye has six extraocular muscles that ultimately control
the eyeball's movement and regulate the eyeball's alignment, or in few cases
misalignment. Strabismus surgery is the rectification of misalignment with the
possible restoration of quality visual activity.
CPT® differentiates the strabismus surgery CPT codes
(67311-67318) by whether the procedure includes horizontal, vertical, or
superior oblique muscles.
Question 2: Is strabismus surgery taken as unilateral or
bilateral?
Answer: The strabismus surgery CPT codes (67311-67318) are
characteristically unilateral, defining procedures carried out in one eye only.
When CPT codes mention more than one muscle, CPT® is denoting that those
muscles are in the same eye. Consequently, in case the surgeon resects one
horizontal muscle in each of the eye, 67312 would not be appropriate. In that
case, report 67311 bilaterally.
Payer preferences differ on the usage of modifiers 50
(Bilateral procedure). A lot of Medicare carrier payers desire that you should
list the code once with the bilateral modifier appended (e.g., 67311-50).
Medicare normally reimburses for 67311-50 based on 150
percent of the specific fee schedule amount for a solitary code. The 2011 fee
schedule allocates 17.16 national unadjusted facility RVUs to 67311, which
earns $583.04 when multiplied by the 33.9764 conversion factor.
Though, in case the ophthalmologist recesses the lateral
rectus along with the definite medial rectus muscles of the left eye, you are
not medical coding a bilateral procedure. This is a case in which 67312 would
be incorrect. CMS would reimburse this at an amount of $705.35 (20.76 RVUs x
33.9764, unadjusted for geographic location).
Hidden trap: The same rules are applicable to the vertical
muscle CPT codes, even though the wording "two or more vertical
muscles" in the definition of 67316 may make you think it's a bilateral
code, as there are precisely only two vertical muscles in one eye.
