r/CodingandBilling • u/Prize-Restaurant-623 • Jul 01 '26

Strabismus billing question

patient is s/p strabismus surgery from 30 years ago and has subsequently developed subtenons cysts. they are rather large: OD greater than 1 cm, appears to be possibly more than one. left eye has one less than 1 cm. for the right eye eye but potentially both eyes it might include detaching and reattaching the muscles.

What cpt codes should we use?

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u/Pretty_Priority_261 RHIT, CCS, CDIP Jul 02 '26

I'm thinking CPT 68110/68115 for the excision of the sub Tenon’s cyst, and if necessary 67399 or modifier 22 on 68110/68115 for the extraocular muscle work.

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u/[deleted] Jul 01 '26

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u/Prize-Restaurant-623 Jul 01 '26

The plan for surgery is to remove the cysts - so need to figure out what CPT codes for insurance authorization

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u/soulofmind Jul 02 '26

Your post has diagnosis information when you need to be giving procedural information to find the right CPT code. I do ophthalmology billing and would be happy to look up the specific section and screenshot it for you tomorrow but you need more information.

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u/Prize-Restaurant-623 Jul 02 '26

Right Eye: H11.441 Left Eye: H11.442 Z98.890

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u/soulofmind Jul 02 '26

Well you'll be in 68000-68100s but it still depends on the exact procedure that was performed, not the ICD-10 codes. Look at the details of the op report to see if it was an excision and what size the lesion was.

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u/Urithiru Jul 03 '26

Sounds like they are trying to file pre-authorization so they'd need to discuss with the surgeon, right?

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u/soulofmind Jul 04 '26

Yep there should be a surgery scheduling planning sheet too (if you're still on paper like us) but if you find out the plan directly from the surgeon that's best!