Ophthalmology and Optometry Coding Alert

Question: A patient had an A-scan at the hospital one week before scheduled glaucoma surgery. Our ophthalmologist interpreted the results the day after the test. Should we code this for the day the test was performed, the day the physician interpreted the results, or the day of the surgery?

New Jersey Subscriber

Answer: You code the interpretation on the date the service took place. Because the test took place in the hospital and not in your practice's office, you will bill only for the professional component of the service, the interpretation of the test results. Report 76519 (Ophthalmic biometry by ultrasound echography, A-scan; with intraocular lens power calculation) with modifier -26 (Professional component). The hospital will bill for the technical component separately.

If your physician interprets test results for only one of the patient's eyes, you should also add an eye modifier (-RT or -LT) to your code. For an A-scan in the case you describe, when the hospital codes the technical component, they will do so for this bilateral test. However, the interpretation of results can be coded separately, once for each eye. If the patient requires interpretation and potentially glaucoma surgery on the other eye afterward, you will have an easier time differentiating the services for your carriers when filing those claims.