Ophthalmology and Optometry Coding Alert

Sharpen your skills, unravel the bilateral rules and get fully reimbursed

One of ophthalmology's most-performed procedures also happens to be one of the most confusing to code properly. Take this quiz to see if your coding for A-scans meets the high standards of your Medicare Part B or private insurer.

Hint: You can find many of the answers in "Coding IOL Masters and A-Scans Together? Read This First" in the February 2005 Ophthalmology Coding Alert.

Question 1: What does Medicare consider included in the global package for 76519 (Ophthalmic biometry by ultrasound echography, A-scan; with intraocular lens power calculation)?

A: The professional component and the technical component performed on both eyes
B: The professional component and the technical component performed on one eye
C: The professional component performed on one eye and the technical component performed on both eyes
D: The professional component performed on both eyes and the technical component performed on one eye

Question 2: The ophthalmologist performs an A-scan prior to cataract surgery on the patient's left eye. He performs the complete test on both eyes and calculates the IOL power in the left eye. The correct coding is:

A: 76519
B: 76519-50
C: 76519-TC-50 and 76519-26-LT
D: 76519-52

Question 3: The ophthalmologist performs an A-scan on both eyes, calculating the IOL power on both sides. The correct coding is:

A: 76519
B: 76519-26-50 and 76519-TC
C: 76519-26 and 76519-TC-50
D: 76519 x 2

Question 4: While performing an IOL master (92136, Ophthalmic biometry by partial coherence interferometry with intraocular lens power calculation), the ophthalmologist performs the technical component on the right eye, with a viable result. However, he cannot get a viable result from the left eye, and must use an A-scan there. He calculates IOL power for one eye. The correct coding is:

A: 92136 and 76519
B: 92136-TC-52-RT, 76519-TC-52-LT and 92136-26
C: 92136 and 76519-26
D: 92136

Question 5: The ophthalmologist performs an A-scan prior to surgery in a patient's left eye. Six months later, the patient returns for an A-scan on his right eye. The correct coding for the right eye is:

A: 76519-RT
B: 76519-26-RT
C: 76519-52
D: 76519-26 and 76519-TC-52

Question 2: A. Based on the bilateral rules explained above, one unit of 76519 represents the work done by performing the technical component on both sides and the professional component (IOL power calculation) on only one side, Morris says.

The global code is marked with bilateral indicator "2", which means that Medicare will not recognize modifier 50 (Bilateral procedure) appended to that code--or to 76519-TC. Modifier 52 (Reduced services) is also not appropriate, since 76519 unmodified describes the service more appropriately.

However: Some carriers do want you to specify which eye the ophthalmologist performed the IOL calculation for. For those carriers, you would report this service as 76519-TC and 76519-26-LT. Check with your carrier for its preference.

Question 3: B. Since 76519-26 is inherently unilateral, you need to append modifier 50 to show that the ophthalmologist performed the IOL calculation on both eyes. Its bilateral indicator of 3 means that Medicare carriers should reimburse you for 200 percent of the RVUs of bilateral 76519-26--the full fee schedule amount for both eyes.

Question 4: D. Although B more accurately describes what the ophthalmologist did, codes 92136 and 76519 are paired in a National Correct Coding Initiative bundle, with a "0" modifier indicator. That modifier indicator prevents you from reporting the two codes together under any circumstances; if you do, Medicare carriers will only reimburse for 92136.

Since, like 76519-TC, the technical component of 92136 is also inherently bilateral, you can report the service with 92136, unmodified.

(For more information, see "Coding IOL Masters and A-Scans Together? Read This First" in the February 2005 Ophthalmology Coding Alert.)

Question 5: B. Only code for the professional component in this case, Morris says. For the second eye calculation done within a year of the first measurements, the technical portion was already performed. Appending the "side" modifier will help keep the clinical picture clear with your carrier.