Ophthalmology and Optometry Coding Alert

Find out when permanently recorded images are a must.

When scouring eye imaging notes, you may see ultrasound mentioned in the documentation, or possibly one of its many aliases — A-scans and B-scans, modes, ophthalmic biometry, ocular echography — and if you don’t know how to translate these descriptions into the correct codes, you risk losing out on rightful reimbursement.

Having a solid understanding of these scans and the details that will direct you to the right code will help you to submit perfect claims for these services, so read on.

Use Sound Waves to Image Eye Structures

When eye care providers need to examine a patient’s intraocular and orbital structures, they often turn to ophthalmic ultrasonography. This procedure, also known as ocular echography, uses high-frequency sound waves to produce detailed images of the patient’s eye and orbit without radiation or contrast material.

“Ocular ultrasound is a quick, noninvasive test used to assess patients for conditions such as retinal detachment or tears,” says Kristen R. Taylor, CPC, CHC, CHIAP, associate partner at Pinnacle Enterprise Risk Consulting Services. Providers may perform ophthalmic ultrasounds to diagnose other conditions, including intraocular tumors, vitreous (gel-like fluid that fills the eye) bleeding, and the presence of foreign bodies.

Break Down Codes Into A- and B-Scans

The radiology chapter of the CPT^® code book breaks down the diagnostic ultrasound codes by body area. Under the head and neck subsection, you’ll find the following ophthalmic ultrasound codes:

• 76510 (Ophthalmic ultrasound, diagnostic; B-scan and quantitative A-scan performed during the same patient encounter)
• 76511 (… quantitative A-scan only)
• 76512 (… B-scan (with or without superimposed non-quantitative A-scan))
• 76513 (… anterior segment ultrasound, immersion (water bath) B-scan or high resolution biomicroscopy, unilateral or bilateral)
• 76514 (… corneal pachymetry, unilateral or bilateral (determination of corneal thickness))
• 76516 (Ophthalmic biometry by ultrasound echography, A-scan)
• 76519 (… with intraocular lens power calculation)

One way to keep up with all of the ultrasound codes is to break them down into two categories: A-scans and B-scans.

A-scans (amplitude scans) provide one-dimensional information about the eye structure and are used to measure tissue thickness and eye length. The density measurements appear as spikes on a graph. The five primary amplitude spikes in an A-scan are produced by the cornea, anterior lens, posterior lens, retina, and sclera.

B-scans (brightness scans) provide cross-sectional, two-dimensional views of ocular structures and are “used for diagnosing lesions of the posterior segment of the eyeball,” Taylor says. B-scan ultrasonography is ideal for diagnosing tumors and evaluating ocular trauma, as mentioned above, in addition to diagnosing and monitoring retinal conditions that cannot be viewed during the physical exam.

Search for These Specifics When Coding

When an ophthalmologist performs an ophthalmic ultrasound that includes both a B-scan and quantitative A-scan during a single patient encounter, assign 76510. When only a quantitative A-scan is performed, report 76511.

Tip: Look for mention of the following to support the B and A tests:

• B-scan: Lesion visualization, shape, borders, and size of the lesion
• A-scan: Spike height, regularity, reflectivity, and sound attenuation

Look to 76512 for ultrasonography with B-scan and non-quantitative A-scan, as well as for a B-scan without a non-quantitative A-scan, as per the descriptor. You’ll use 76512 when the physician’s view with the ophthalmoscope or biomicroscope is obstructed, advises Vanderwall.

Medicare’s National Correct Coding Initiative (NCCI) Procedure-to-Procedure edits pair 76512 with 76511. “Coders should be aware of NCCI edits on 76511/76512. The A-scan is inclusive to the procedure for the B-scan,” says Chelsea Kemp, RHIT, CCS, COC, CPC, CDEO, CPMA, CRC, CCC, CEDC, CGIC, AAPC-Approved Instructor, outpatient coding educator/auditor at Yale New Haven Health in New Haven, Connecticut.

Coding tip: CPT^® codes 76510-76513 are considered unilateral, so when these scans are performed on both eyes, you must use modifiers LT (Left side), RT (Right side), 50 (Bilateral procedure), or a units value of “2.” But 76516 and 76519 are inherently bilateral and shouldn’t have modifier 50 appended to them, nor should 76514, as its descriptor specifies “unilateral or bilateral.”

Know When to Report Just Interpretation or Technical Component

The diagnostic ophthalmic ultrasound codes listed above consist of professional and technical components. When different healthcare providers perform these components, you’ll need to append the correct modifier to the appropriate procedure code.

If the provider performs just the ophthalmic ultrasound procedure, and there is no interpretation of the results, then you’ll append modifier TC (Technical component …) to the ultrasound code to indicate the technical portion of the scan.

In situations where a provider interprets the results but doesn’t perform the ultrasound, you’ll append modifier 26 (Professional component) to the applicable CPT^® code.

However, if your practice owns the ultrasound equipment and a physician from the practice interprets the test results, the claim will not require any modifiers.