Ophthalmology and Optometry Coding Alert

If you look up either code in the Medicare Physician Fee Schedule, you’ll see that it says “no 150 percent payment boost” applies. But this situation goes deeper than that because CMS divides the A-scan (76519) and the IOL Master (92136) into two components. The technical component (the actual performance of the test) is denoted with modifier TC (Technical component), and the professional component (viewing and interpreting the results) is denoted with modifier 26 (Professional component).

For both 76519 and 92136, the technical component has a different bilateral status from the professional component.

You can find the bilateral surgery indicators in the fee schedule. Both 76519-TC and 92136-TC are denoted with modifier indicator “2,” which means that the technical component of the codes is considered inherently bilateral.

The work of performing the test on both eyes is included when reporting the CPT^® codes — you should report 76519-TC or 92136-TC only once, whether the eye care provider tests one or both eyes.

The professional components (76519-26 and 92136-26) are denoted with modifier indicator “3,” however, which means that the professional component of the codes is inherently unilateral.

Why? An eye care provider usually performs the technical component of the procedure — the actual measurement of the eye — on both eyes at the same time on the same day. But they may only perform the professional component — the IOL power calculation — on the eye that is going to have surgery.

When the decision is made to perform cataract surgery on the fellow eye, the initial measurement is used. Modifier 26 is appended to the code to seek reimbursement for the professional component. Keep in mind, however, that payers may be hesitant to reimburse claims with both modifier 26 and modifier 50 (Bilateral procedure) since the professional component on the second eye is not medically necessary until the decision is made to proceed with surgery on both eyes. If the eye care physician calculates IOL power in both eyes, code the technical and professional components separately. For example, for an IOL Master and power calculation in both eyes, code:

• 92136-TC for the bilateral technical component
• 92136-26-50 for the bilateral professional component. Append modifier 50 (Bilateral procedure) to show that you bilaterally performed this usually unilateral component.

Alternatively, some payers require you to report these services as follows:

• 92136-26-RT and 92136-26-LT.