Ophthalmology and Optometry Coding Alert

Reader Questions:

Drill Down to Diagnoses That Support Dual Scans

Published on Wed Mar 22, 2023

Question: Which diagnoses support the performance of diagnostic ophthalmic ultrasound with both B- and A-scans, and what diagnosis codes should we report when billing 76510/76512 to help prove medical necessity?

Michigan Subscriber

Answer: Physicians may use diagnostic ophthalmic ultrasonography with both B- and A-scans for a variety of conditions, including (but not limited to) malignant and benign neoplasms; diabetic cataracts; and suspected retinal, choroid, or vitreous detachments. This imaging helps them to fully assess the condition of the eye and the extent of the disease or abnormality. Familiarity with the following ranges will serve you well as you connect the correct ICD-10-CM code to the condition detailed in the written report for the scan.

Neoplasms

For malignant neoplasms, you’ll use a code in the C69.00- C69.82 range, selecting the 4th and 5th digits depending on the lesion’s location.

The same principle holds for benign neoplasms: Select a code from the D31.00-D31.92 set and assign the last two digits to match the lesion location notes in the procedure report.

Diabetic Cataracts

When a patient has cataracts it’s hard for the doctor to see into the back of the eye, and ultrasonography helps with visualization of internal structures. For patients with documented diabetes, you’ll report one of these two codes, depending on the diabetes type:

E10.36 (Type 1 diabetes mellitus with diabetic cataract)
E11.36 (Type 2 diabetes mellitus with diabetic cataract).

Code it: For instance, if a patient with type 2 diabetes and cataracts has ophthalmic ultrasonography, with both a B-scan and quantitative A-scan, done in the office and your doctor provides the scan interpretation, you’d report 76510 for the ultrasound service and E11.36 for the diagnosis code.

Retinal Detachment

If the scan confirms a detached retina with multiple breaks in the left eye, you’ll use H33.022 (Retinal detachment with multiple breaks, left eye) from the H30-H36 “Disorders of Choroid and Retina” code set.

Do this: Before billing out the service, check with your payer. As with all your claims, you’ll beat the odds of proving medical necessity if you’ve reported specific diagnosis codes that match your carrier’s requirements for the ultrasound service.