Ophthalmology and Optometry Coding Alert

Question: Our ophthalmologist submitted 76510-RT for the following case, but we received a denial. Can you explain what the appropriate codes and modifiers are for this scenario?

A 65-year-old patient presents with complaints of flashes of light and floaters in their right eye. The ophthalmologist performs a dilated eye examination and refers the patient to an outpatient radiology practice for an ophthalmic ultrasound that includes a B-scan and non-quantitative A-scan to get a better look at the retina. Following the ultrasound, the ophthalmologist interprets the results and diagnoses the patient with a single-break retinal detachment.

Washington Subscriber

Answer: In this scenario, a radiologist performs ophthalmic ultrasonography while the ophthalmologist interprets the results. The radiologist would report 76512 (Ophthalmic ultrasound, diagnostic; B-scan (with or without superimposed non-quantitative A-scan)) for the B-scan and non-quantitative A-scan and append modifier TC (Technical component …) since their facility owns the equipment and they performed the procedure. The ophthalmologist will report 76512 with modifier 26 (Professional component) appended for the interpretation. You may also append modifier RT (Right side) to the CPT^® code to provide information on laterality.

Remember: CPT^® code 76512 is considered unilateral, so when these scans are performed on both eyes, you must use modifiers LT (Left side), RT (Right side), 50 (Bilateral procedure), or a units value of “2.”

Diagnosis roundup: To report the patient’s diagnosis, you’ll search for Detachment > retina > with retinal: > break > single in the ICD-10-CM code set Alphabetic Index, where you’ll find H33.01 (Retinal detachment with single break). When you verify the code in the tabular list, you’ll see the subcategory requires a 6th character to complete the code. The patient is experiencing the retinal detachment in their right eye, so you’ll select H33.011 (Retinal detachment with single break, right eye) with 6th character 1 indicating the right eye.