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Transposition of the extraocular muscles is a surgical procedure that involves the detachment and repositioning of an extraocular muscle to a new location on the eye globe. This procedure is specifically indicated for cases where there is paralysis or paresis of an extraocular muscle, which can occur due to damage to the cranial nerves responsible for eye movement, namely cranial nerves III (oculomotor), IV (trochlear), or VI (abducens). The transposition procedure is typically performed in conjunction with another strabismus surgery that is separately reportable, meaning it is billed in addition to the primary procedure. The surgical approach begins with a conjunctival incision made over the muscle or muscles that are to be manipulated. Following the incision, the targeted muscle(s) is carefully detached from its original attachment on the globe, repositioned to a new location, and then secured in place using sutures. Finally, the conjunctival incision is closed, completing the procedure. This surgical intervention aims to improve ocular alignment and restore function in patients with specific types of strabismus related to muscle dysfunction.
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Transposition of the extraocular muscles is indicated for the following conditions:
The transposition procedure involves several key steps that are performed with precision to ensure optimal outcomes.
After the transposition procedure, patients typically require monitoring for any immediate complications. Post-operative care may include the use of topical antibiotics to prevent infection and anti-inflammatory medications to manage discomfort. Patients are often advised to avoid strenuous activities for a specified period to allow for proper healing. Follow-up appointments are essential to assess the alignment of the eyes and the overall success of the procedure. The expected recovery time can vary, but most patients will begin to notice improvements in ocular alignment as they heal.
| Short Descr | REVISE EYE MUSCLE(S) ADD-ON | Medium Descr | TRANSPOSITION PROCEDURE EXTRAOCULAR MUSC | Long Descr | Transposition procedure (eg, for paretic extraocular muscle), any extraocular muscle (specify) (List separately in addition to code for primary procedure) | Status Code | Active Code | Global Days | ZZZ - Code Related to Another Service | PC/TC Indicator (26, TC) | 0 - Physician Service Code | Multiple Procedures (51) | 0 - No payment adjustment rules for multiple procedures apply. | Bilateral Surgery (50) | 0 - 150% payment adjustment for bilateral procedures does NOT apply. | Physician Supervisions | 09 - Concept does not apply. | Assistant Surgeon (80, 82) | 1 - Statutory payment restriction for assistants at surgery applies to this procedure... | Co-Surgeons (62) | 0 - Co-surgeons not permitted for this procedure. | Team Surgery (66) | 0 - Team surgeons not permitted for this procedure. | Diagnostic Imaging Family | 99 - Concept Does Not Apply | APC Status Indicator | Items and Services Packaged into APC Rates | ASC Payment Indicator | Packaged service/item; no separate payment made. | Type of Service (TOS) | 2 - Surgery | Berenson-Eggers TOS (BETOS) | P4E - Eye procedure - other | MUE | 2 | CCS Clinical Classification | 21 - Other extraocular muscle and orbit therapeutic procedures |
This is an add-on code that must be used in conjunction with one of these primary codes.
| 67311 | MPFS Status: Active Code APC J1 ASC A2 CPT Assistant Article Illustration for Code Strabismus surgery, recession or resection procedure; 1 horizontal muscle | 67312 | MPFS Status: Active Code APC J1 ASC A2 CPT Assistant Article Illustration for Code Strabismus surgery, recession or resection procedure; 2 horizontal muscles | 67314 | MPFS Status: Active Code APC J1 ASC A2 CPT Assistant Article Illustration for Code Strabismus surgery, recession or resection procedure; 1 vertical muscle (excluding superior oblique) | 67316 | MPFS Status: Active Code APC J1 ASC A2 CPT Assistant Article Illustration for Code Strabismus surgery, recession or resection procedure; 2 or more vertical muscles (excluding superior oblique) | 67318 | MPFS Status: Active Code APC J1 ASC A2 CPT Assistant Article Illustration for Code Strabismus surgery, any procedure, superior oblique muscle | 67335 | Addon Code MPFS Status: Active Code APC N ASC N1 CPT Assistant Article Illustration for Code Placement of adjustable suture(s) during strabismus surgery, including postoperative adjustment(s) of suture(s) (List separately in addition to code for specific strabismus surgery) | 67340 | Addon Code MPFS Status: Active Code APC N ASC N1 CPT Assistant Article Illustration for Code Strabismus surgery involving exploration and/or repair of detached extraocular muscle(s) (List separately in addition to code for primary procedure) |
| RT | Right side (used to identify procedures performed on the right side of the body) | 50 | Bilateral procedure: unless otherwise identified in the listings, bilateral procedures that are performed at the same session, should be identified by adding modifier 50 to the appropriate 5 digit code. note: this modifier should not be appended to designated "add-on" codes (see appendix d). | 51 | Multiple procedures: when multiple procedures, other than e/m services, physical medicine and rehabilitation services or provision of supplies (eg, vaccines), are performed at the same session by the same individual, the primary procedure or service may be reported as listed. the additional procedure(s) or service(s) may be identified by appending modifier 51 to the additional procedure or service code(s). note: this modifier should not be appended to designated "add-on" codes (see appendix d). | 59 | Distinct procedural service: under certain circumstances, it may be necessary to indicate that a procedure or service was distinct or independent from other non-e/m services performed on the same day. modifier 59 is used to identify procedures/services, other than e/m services, that are not normally reported together, but are appropriate under the circumstances. documentation must support a different session, different procedure or surgery, different site or organ system, separate incision/excision, separate lesion, or separate injury (or area of injury in extensive injuries) not ordinarily encountered or performed on the same day by the same individual. however, when another already established modifier is appropriate it should be used rather than modifier 59. only if no more descriptive modifier is available, and the use of modifier 59 best explains the circumstances, should modifier 59 be used. note: modifier 59 should not be appended to an e/m service. to report a separate and distinct e/m service with a non-e/m service performed on the same date, see modifier 25. | 76 | Repeat procedure or service by same physician or other qualified health care professional: it may be necessary to indicate that a procedure or service was repeated by the same physician or other qualified health care professional subsequent to the original procedure or service. this circumstance may be reported by adding modifier 76 to the repeated procedure or service. note: this modifier should not be appended to an e/m service. | 78 | Unplanned return to the operating/procedure room by the same physician or other qualified health care professional following initial procedure for a related procedure during the postoperative period: it may be necessary to indicate that another procedure was performed during the postoperative period of the initial procedure (unplanned procedure following initial procedure). when this procedure is related to the first, and requires the use of an operating/procedure room, it may be reported by adding modifier 78 to the related procedure. (for repeat procedures, see modifier 76.) | 79 | Unrelated procedure or service by the same physician or other qualified health care professional during the postoperative period: the individual may need to indicate that the performance of a procedure or service during the postoperative period was unrelated to the original procedure. this circumstance may be reported by using modifier 79. (for repeat procedures on the same day, see modifier 76.) | GC | This service has been performed in part by a resident under the direction of a teaching physician | LT | Left side (used to identify procedures performed on the left side of the body) | XS | Separate structure, a service that is distinct because it was performed on a separate organ/structure | XU | Unusual non-overlapping service, the use of a service that is distinct because it does not overlap usual components of the main service |
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