Ophthalmology and Optometry Coding Alert

Don't let faulty diagnosis coding shortchange your claims

Medicare covers IOL calculation procedures for patients about to undergo cataract surgery. But just listing 366 (Cataract) as your diagnosis code is likely to get your claim denied.

Below is a list of specific ICD-9 codes that most carriers recognize as demonstrating medical necessity for both 76519 (Ophthalmic biometry by ultrasound echography, A-scan; with intraocular lens power calculation) and 92136 (Ophthalmic biometry by partial coherence interferometry with intraocular lens power calculation).
 

An article in the February 2005 Ophthalmology Coding Alert, "Coding IOL Masters and A-Scans Together? Read This First," referred to a "modifier indicator" found in the Medicare National Physician Fee Schedule Relative Value File. The correct term is "bilateral surgery indicator."
 
Bilateral surgery indicators, found for each CPT code in column "T" of the fee schedule database, determine how Medicare reimburses codes that are reported bilaterally.
 
We apologize for any confusion we may have caused.