Ophthalmology and Optometry Coding Alert

Many ophthalmologists have a hard time with claims for A-scans with intraocular lens (IOL) implant power calculations, especially whenas is often the casethey have to be done more than once on the same patient. The problem is that many coders dont have any idea what Medicares payment policy is for A-scans with IOL calculations (76519), a service that must be done before cataract surgery.

And no wonder. It is one of the most confusing policies on Medicares books. In fact, A-scans are the only service in ophthalmology for which Medicare has determined two separate payment policiesone for the technical component, and one for the professional component. The code for the entire measurement and IOL calculation process, known commonly as an A-scan, is 76519 (ophthalmic biometry by ultrasound echography, A-scan; with intraocular lens power calculation). Lise Roberts, an ophthalmology coding and compliance consultant and vice president of Healthcare Compliance Strategies, based in Syosset, NY, explains how A-scan coding works.

Understanding Technical and Professional Components is Key

1. The technical component: The actual measuring of the eye is the technical portion of 76519. An A-scan is an ultrasonic instrument which measures the eye from the front of the cornea to the back of the retina. It measures the axial length of the eye. Keratometry, a separate procedure, measures the shape of the cornea. Virtually all ophthalmologists have equipment which automatically takes these two pieces of information and turns them into a calculation for the power of the intraocular lens implant. Medicare only allows the technical component to be billed once a year unless there is medical necessity to do it again in less than that time.

2. The professional component: Calculating and selecting the power of the IOL to implant is the professional portion of 76519. But there is not just one power that is calculated, Roberts explains. Instead, a range of powers is given that might be appropriate. The ophthalmologist selects the power that he or she wants to insert, based on various considerations, she says. Close to planoor perfect visionis not always the best, because the other eye may be very farsighted, for example. You dont want one eye to be totally out of sync with the other eye, Roberts notes. In addition to picking the power of the IOL, the ophthalmologist picks the style. The professional component can be billed for each cataract surgery regardless of the time interval between operations.

Medicares Payment Policies

Medicares policy defines the technical component as a bilateral code. In other words, Roberts explains, when you bill 76519, payment for the technical component for both eyes is included in the Medicare fee schedule. The professional component, however, is defined by a unilateral code. So [...]