Optometry Coding & Billing Alert
Clear Up Cataract Coding
Question: A Medicare patient presented with a cataract in his right eye. Our optometrist performed an A-scan with intraocular lens (IOL) calculation in preparation for cataract removal. I coded 76519-RT-LT-26 and Medicare rejected it. Both eyes were scanned for comparison. What did I do wrong? Answer: Code 76519 (Ophthalmic biometry by ultrasound echography, A-scan; with intraocular lens power calculation) accounts for the technical component of both eyes but only the professional component of the right eye (the one with the cataract). -- Answers to You Be the Expert and Reader Questions contributed by David R. Gibson, OD, FAAO, a partner in an optometric partnership in Lubbock, Texas.
New Mexico Subscriber
If and when cataract surgery is performed on the left eye, the optometrist will typically use the same ultrasound, compare the patient's visual outcome with the first IOL selection, and select the IOL power for the fellow eye.
Other private carriers vary on what billing method they will accept for 76519. Some carriers will pay for 76519-RT followed by 76519-LT a few weeks later, without requiring you to use modifier -26 (Professional component), because they consider 76519 inherently unilateral. Don't make the mistake of only billing the professional component of 76519 assuming you have already been reimbursed for the technical component for both eyes -- check with the patient's insurance carrier first.
Optometry Coding & Billing Alert
- Coding Corner:
Avoid Denials by Linking These ICD-9 Codes to Ophthalmoscopies
Use 362.81 to get paid for 92225
If you are linking ophthalmoscopy procedures to a diagnosis [...] - Billing Basics:
Plug Up 68761 Reimbursement With This Expert Strategy
Hint: Modifier -50 won't get all 2-plug claims paid
Modifiers pose the greatest difficulty when [...] - HIPAA Help Desk:
Keep Tabs on Floppies and CDs Containing Patient Info
Follow these 6 tips to remain HIPAA-compliant
If you leave the office with portable media such [...] - Reader Question:
Fix Faxing for HIPAA Compliance
Question: I accidentally reversed two digits of a fax number and faxed medical information to [...] - You Be The Expert:
Take Pressure Off Glaucoma Dx Coding
Question: We had a patient present with high intraocular pressure, a symptom of glaucoma, and [...] - Reader Question:
Don't Take the Money and Run
Question: How should I handle overpayments by insurers? How fast do I have to repay? [...] - Reader Question:
Catch More Copays With These Billing Tips
Question: One of the most unpleasant chores in our office is collecting copays. We have [...] - Reader Question:
Don't Get Mad, Get Reimbursed
Question: One of our private carriers is denying 92250 when performed on the same day [...] - Reader Question:
Get Tough on Bounced Checks
Question: Every once in a while, a patient's check bounces. We not only lose the [...] - Reader Question:
Fight for After-Hours Reimbursement
Question: I saw a patient at 5 a.m. on a holiday for a corneal ulcer. [...] - Reader Question:
Clear Up Cataract Coding
Question: A Medicare patient presented with a cataract in his right eye. Our optometrist performed [...]
