What CPT (Current Procedural Terminology) code(s) are reported for the placement of two adjustable sutures during strabismus surgery involving the horizontal muscles?

CPT Coding for Adjustable Sutures in Horizontal Strabismus Surgery

The correct CPT code for placement of two adjustable sutures during strabismus surgery involving the horizontal muscles is 67316,67335-51.

Understanding the Coding Requirements

When coding for strabismus surgery with adjustable sutures, it's important to understand the components involved:

1. Base Procedure Code:

   • 67316 is the appropriate code for strabismus surgery on two horizontal muscles in one or both eyes 1
   • This code covers the primary surgical procedure on the horizontal muscles

2. Add-on Code for Adjustable Sutures:

   • 67335 is the add-on code specifically for placement of adjustable sutures during strabismus surgery 1
   • The -51 modifier indicates multiple procedures performed during the same operative session

Why This Is the Correct Coding

The procedure described involves two distinct billable components:

• Surgery on two horizontal muscles (67316)
• Placement of two adjustable sutures (67335-51)

Clinical Context for Adjustable Suture Technique

Adjustable sutures are particularly valuable in adult strabismus surgery for several reasons:

• They provide a second chance at obtaining satisfactory alignment post-operatively 2
• They help minimize the risk of post-operative diplopia 2
• They are especially helpful in reoperations and unpredictable cases, such as those with restrictive or paralytic strabismus 2

Various techniques for adjustable sutures exist (bowtie, noose, semiadjustable), and adjustment timing varies by surgeon preference - from immediately in the operating room to several days following the procedure 2.

Coding Pitfalls to Avoid

1. Common Coding Errors:

   • Using 67312 (which is for vertical muscles, not horizontal)
   • Omitting the 67335 add-on code for the adjustable suture technique
   • Forgetting the -51 modifier when reporting multiple procedures

2. Documentation Requirements:

   • Clearly document which specific horizontal muscles were operated on
   • Note that adjustable sutures were placed
   • Include any special circumstances that justified the use of adjustable sutures 1

Outcomes and Considerations

Research shows that adjustable suture techniques have demonstrated significant improvement in strabismus angle following one operation in approximately 86% of cases 3. The technique has shown particular value in:

• Selected horizontal deviations
• Complex strabismus problems
• Cases where postoperative alignment is less predictable 4

Long-term studies indicate that adjustable sutures may produce better surgical results than non-adjustable surgery for certain types of strabismus, particularly when the surgical goal is long-lasting maintenance of alignment 5.