Ophthalmology and Optometry Coding Alert

Answer: Before a patient can present for cataract surgery, your eye care specialist needs to calculate their intraocular lens (IOL) power, which you will report with 76519 (Ophthalmic biometry by ultrasound echography, A-scan; with intraocular lens power calculation) or 92136 (Ophthalmic biometry by partial coherence interferometry with intraocular lens power calculation) as you say.

However, you will need to take into account the professional and technical components of the code by using modifiers TC (Technical component) and 26 (Professional component) on the claim. This will, in turn, determine how you will use laterality modifiers RT (Right side), LT (Left side) or 50 (Bilateral procedure) for correct billing.

Rationale: In general, an eye care provider 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 will only perform the professional component — the IOL power calculation — on the eye the patient will have surgery on.

So, if the provider measures both eyes but performs the IOL power calculation on the right eye only, you would bill 92136 alone or like this:

• 92136-TC for the bilateral technical component
• 92136-26-RT for the professional component on the right eye

Why? For 92136-TC, the bilateral indicator in the Medicare Physician Fee Schedule is “2,” meaning the technical component of the code is considered inherently bilateral. In other words, you bill 92136-TC with no laterality modifier, depending on payer preference, whether the optometrist tests one or both eyes.

For 92136-26, the bilateral indicator in the Medicare Physician Fee Schedule is “3,” meaning the professional component of the code is considered inherently unilateral. In other words, you bill 92136-26 with a laterality modifier such as RT, LT or 50, depending on payer preference, if the optometrist tests one eye (RT or LT) or both eyes (50).