Ophthalmology and Optometry Coding Alert

Lesion details and a spike graph are your clues.

Submitting perfect claims for your physician’s diagnostic ophthalmic ultrasound services is possible if you’re careful about scouring the report for details on the scan type and measurements generated from the test.

Can You Scan This For Me?

An ophthalmologic ultrasound is a diagnostic test which uses high-frequency sound waves to diagnose a range of disorders, according to an article about the topic on the American Academy of Ophthalmology (AAO) site. Those reasons include:

• to obtain globe length so that the physician can calculate corrective lens power requirements;
• to measure tumors including choroidal melanomas;
• to visualize lens dislocation; and
• to detect retinal detachment.

Dense clouds: The test, a.k.a. ultrasonography, is particularly useful when the fundus “is obscured from visualization by slit lamp and laser interferometry (IOL Master), as in patients with dense cataracts” or vitreous hemorrhage, says the article, and for this group, the ultrasonography “may result in earlier detection of ocular melanoma.”  

Plusses and minuses: Ultrasound is safe, doesn’t expose the patient to radiation, is widely available, and is low cost, the AAO article says.

On the downside, it’s a test that varies depending on who’s performing it, which doesn’t “plague other forms of imaging including optical coherence tomography, CT, and MRI,” the AAO advises. “This is due to the procedure code having both a technical and a professional component,” says Gina Vanderwall, OCS, CPC, CPPM, financial counselor with Finger Lakes Ophthalmology of Canandaigua, NY. “So it not only depends on who is performing it (location and who owns the testing equipment), but also who is interpreting the test.”

76510 Includes Dual Scans

You’ll report 76510 (Ophthalmic ultrasound, diagnostic; B-scan and quantitative A-scan performed during the same patient encounter) when your provider’s work during a single patient encounter includes both a brightness scan (B-scan), which uses echo detection to highlight lesions and other abnormalities, and an amplitude scan (A-scan), which measures structure density as spikes on a graph.

Tip: Look for notes on items such as the following to support the B and A tests for this procedure:

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

For example: Your doctor may use both B and A scans for a patient with suspected retinal, choroid, or vitreous detachments to fully assess the condition of the eye and the extent of the disease or abnormality.

When your provider performs just an A-scan, you’ll report 76511 (Ophthalmic ultrasound, diagnostic; quantitative A-scan only) to reflect the density measurement testing.

A-only indications: The diagnostic A-scan has limited use, says Vanderwall. It’s best-suited for looking at the internal reflectivity of certain conditions, such as helping the provider “make a definitive diagnosis between what may be a disciform scar as opposed to a choroidal melanoma.”

For a B-scan with or without a non-quantitative A-scan, report 76512 (Ophthalmic ultrasound, diagnostic; B-scan (with or without superimposed non-quantitative A-scan)).

B-scan circumstances: You’ll use 76512 when the physician’s view with the ophthalmoscope or biomicroscope is obstructed, advises Vanderwall.

Just Interp or Tech?

If your ophthalmologist doesn’t perform the ultrasound itself but interprets the results, you’ll append modifier 26 (Professional component) to 76510, 76511, or 76512, depending on whether the test included both B and A scans, A-only, or B-only. “If you are a private practice, own the equipment used to perform the ultrasound, and your doctor interprets the test, no modifiers are required,” says Vanderwall.

For situations when you’re reporting only the technical portion of the scan, you’ll append modifier TC (Technical component) to the appropriate ultrasound code unless a hospital provided the technical component. In that case, you wouldn’t append modifier TC because the hospital’s portion is inherently technical.

Don’t Forget the Images — and the Report

Think of your ultrasound records like your Instagram account: Without pictures, there’s not much point — and nothing to show the procedure actually happened.

Drilling down: CPT^® guidelines state that all diagnostic ultrasound examinations “require permanently recorded images with measurements, when such measurements are clinically indicated,” unless the “sole diagnostic goal is a biometric measure (i.e., 76514, 76516, and 76519).”

That means, for your ophthalmic ultrasound reports, you’ll need to ensure that all visualization details, including lesion or abnormality measurements, are clearly indicated in your physician’s final, written report in the patient’s medical record.

Resource: To read the article on the American Academy of Ophthalmology’s site, go to https://eyewiki.aao.org/Ophthalmologic_Ultrasound.