Forum - Questions & Answers

Nov 23rd, 2010 - tracyc271 30 

Please help! ASAP!

Can someone please help ASAP with coding an op note...
Procedure was: Re-recession right medial rectus with inferior transposition and recession with left medial rectus with inferior transposition

Note states-

With the patient under general anesthesia the area around both eyes was prepped with Betadine and sterile drapes applied in the usual manner. Attention was directed toward the right eye. The lid speculum was put into place. The globe was held in abduction with 4-0 silk traction sutures. A fornix based conjunctival flap was developed over the right medial rectus and the muscle was dissected away from adjacent scar tissue. The muscle was located at an original position of about 3-mm. posterior to the insertion. A double-armed suture of 6-0 vicryl was looped through the muscle near the insertion with locking bites placed at the upper and lower edges of the muscle and the muscle was cut from the globe and sewn back to the sclera position recessed 2-mm. posterior to the insertion stump and this placed one third tendon width inferiorly. The sutures were then tied and cut and the conjunctiva was then replaced at the limbus and held there with interrupted 9-0 vicryl. Attention was then paid to the left medial rectus. The globe was elevated upward and outward exposing the inferior nasal fornix. Incision through conjunctiva and Tenon’s capsule in this area allowed access to the left medial rectus which was grasped with a muscle hook and dissected away from adjacent tissue. A double-armed suture of 6-0 vicryl was looped through the muscle near the insertion with locking bites placed at the upper and lower edges of the muscle and the muscle was cut from the globe and sewn back to the sclera position recessed 3-mm. posterior to the insertion and displaced one third tendon width inferiorly. The new incision was checked and found to be secure and the conjunctiva was then replaced and held with interrupted 9-0 vicryl. Maxitrol was placed in both eyes and the patient tolerated the procedure well and left the operating room in good condition

Question is- Is this considered transposition of a muscle(67320) or just 67311?

Thank you much!

Nov 23rd, 2010 - nmaguire   2,606 

diagnosis code?

Transposition procedure. A transposition procedure is performed when a patient has lost functioning in one of the extraocular muscles…An add-on code is not used for minor transpositions of a muscle coincident to a recession or resection. Transposition procedures are coded when the surgical procedure is for correction of a paretic/paralyzed muscle—not for raising or lowering the insertions of muscles for correction of A or V pattern. You may code it once per eye but not per muscle.



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