Ophthalmology and Optometry Coding Alert
Avoid Bilateral Modifiers on 76519, 92136
Question: New Jersey Subscriber Answer: RT (Right side) and LT (Left side), or modifier 50 (Bilateral procedure). You may also be tempted to report 92136 (Ophthalmic biometry by partial coherence interferometry with intraocular lens power calculation) using the bilateral modifiers. Reality: You should not report 76519 or 92136 bilaterally, even if the ophthalmologist calculated the intraocular (IOL) power of both eyes. To understand why, it's helpful to know how Medicare's Physician Fee Schedule values the procedures. As it does with many diagnostic tests, CMS divides the A-scan (76519) and the IOL Master (92136) into two components: the technical component (the actual perform-ing of the test, modifier TC), and the professional com-ponent (viewing and interpreting the results, modifier 26). For most procedures, the technical and professional components have the same bilateral status -- for example, 92250-TC and 92250-26 (Fundus photography with interpretation and report) are both considered inherently bilateral, designated with modifier indicator "2" on the fee schedule. The reimbursement for all components of 92250 is based on both eyes being tested. Exception: For both 76519 and 92136, the technical component has a different bilateral status than the professional component. Both 76519-TC and 92136-TC are designated with modifier indicator "2," which means that the technical components of these codes are considered inherently bilateral. But 76519-26 and 92136-26 are designated with modifier indicator "3," which means that Medicare payers will not apply the usual payment adjustment for bilateral procedures. The technical work for performing the procedure on both eyes is included in the single CPT codes. Therefore, you should report 76519-TC or 92136-TC only once, whether the ophthalmologist tests one or both eyes. Check with your local carrier to determine how the technical and professional components of these services should be reported. Here are two examples: Example 1: 76519-26-RT 76519-26-LT 76519-TC Example 2: 76519-26-50 76519-TC Note:
Ophthalmology and Optometry Coding Alert
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