Ophthalmology and Optometry Coding Alert

A-scans and B-scans have more than one alias ultrasounds, ophthalmic biometry, modes and if you don't know how to translate these descriptions into the accurate codes, you shouldn't expect to earn your rightful reimbursements. The slight nuances between code descriptors determine whether a code is directly applicable to a coding scenario as well as the rules for billing the scan if performed bilaterally, especially for the following diagnostic ultrasound codes: 76511 Ophthalmic ultrasound, echography, diagnostic; A-scan only, with amplitude quantification 76512 contact B-scan (with or without simultaneous A-scan) 76513 anterior segment ultrasound, immersion (water bath) B-scan or high-resolution biomicroscopy 76516 Ophthalmic biometry by ultrasound echography, A-scan 76519 with intraocular lens power calculation. Break Down Codes into A- and B-scans 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, 76511, 76516 and 76519, are the shortened names for A-mode scans, one-dimensional ultrasonic measurement procedures, CPT says. According to Georgia Medicare, the A-scans perform the following functions: 76511 diagnoses eye-related complications such as eye tumors, hemorrhages, retinal detachment, etc.; 76516 determines the length of the eye; and 76519 determines the intraocular lens calculation prior to cataract surgery only. Each A-scan code has separate requirements when billed bilaterally; for example, 76511 is considered unilateral, requiring the use of modifiers -LT/-RT/-50 (Left, Right, or Bilateral procedure) or the units value of "2." But 76516 is considered inherently bilateral and shouldn't have modifier -50 appended to it. Codes have bilateral "indicators" from the fee schedule, which should be national, says Raequell Duran, president of Practice Solutions in Santa Barbara, Calif. How you bill bilateral scans really depends on the service and code used. Unfortunately, Medicare makes this even more complicated by determining the technical component of one of the A-scan codes to be bilateral, and the calculation, or professional component, to be unilateral, says Brenda Parker, CPC, assistant administrator for River Cities Ophthalmology in Fort Madison, Iowa. Many non-Medicare carriers, on the other hand, want you to bill by line and don't typically divide the professional and technical components, she says, so it is imperative that you determine which carrier you are coding for and what its policy is for billing A-scans.

Because most patients who have cataract surgery are of Medicare age, it should not be too often that you have to be concerned with changing your billing procedure for 76519, Duran says. B-scans, 76512 and 76513, are more straightforward. These ultrasounds evaluate the interior of the eye noninva-sively, when the patient has a mature cataract. The visual image of the eye is often used to determine the condition of the eye before cataract surgery. In the Medicare program, CPT [...]