Ophthalmology and Optometry Coding Alert

Question: When billing the second eye for an A-scan what is the best way to code it and with what modifiers?

California Subscriber

Answer: There are two payment policies for A-scans one for the technical component (TC) and one for the professional component (-26). The code for the A-scan is 76519 (ophthalmic biometry by ultrasound echography, A-scan; with intraocular lens power calculation). Code 76519 is the global billing for the A-scan, meaning that it equals one technical component (76519-TC) and one professional component (76519-26). The technical component represents the actual measuring of the eye. The professional component signifies the calculation and selection of the power of the IOL to implant. Medicare identifies the technical component (76519-TC) as a bilateral payment, thus Medicare will make one payment for both eyes. The professional component (76519-26) is unilateral, which means Medicare pays it per eye. When both eyes are tested and interpreted, you should receive a total payment for one technical component and two interpretations (76519 + 76519-26 or 76519-TC + 76519-26-RT + 76519-26-LT). If you have submitted an initial billing of 76519 for the first eye and are performing the A-scan calculation for the second eye, you would bill 76519-26 with the eye modifier (-LT or -RT). This way, you would be paid only for the professional component for that second eye, as you would have already been paid for the technical component the actual measuring when you submitted the global billing of 76519.