Optometry Coding & Billing Alert
Ask Carrier for 76514 Policy
Question: What's the correct procedure code for pachymetry? Which ICD-9 codes are covered? Answer: TrailBlazer, the Medicare Part B carrier for Texas, has not published a specific local coverage determination (LCD) for 76514 (Ophthalmic ultrasound, echography, diagnostic; corneal pachymetry, unilateral or bilateral [determination of corneal thickness]). And since the code is still relatively new - it was introduced on Jan. 1, 2004 - there is as yet no national policy for 76514. This means that right now there is no definitive list of ICD-9 codes that support medical necessity for corneal pachymetry for providers in Texas. Many carriers will only reimburse for pachymetry once in a lifetime for each patient per doctor. The pachymetry never changes, they say, so they won't allow it more than once. Also note that the fee for the code is divided into professional and technical components, requiring modifiers -26 (Professional component) and -TC (Technical component). - Advice for Reader Questions and You Be the Expert contributed by David Gibson, OD, FAAO, practicing optometrist in Lubbock, Texas; and Charles Wimbish, OD, president of Wimbish Consulting Group in Martinsville, Va.
Texas Subscriber
However: Several other carriers have published LCDs for 76514, and you can use them as a starting point. For example, the LCD published by Arkansas Blue Cross and Blue Shield (the Part B contractor for Louisiana, Oklahoma, eastern Missouri and New Mexico), lists these diagnosis codes:
Do this: Call your carrier and ask about its policy for 76514. If the carrier can't provide you a list of approved ICD-9 codes, cite the above list.
Tip: You can search for coverage determinations online at www.cms.hhs.gov/mcd/search.asp?.
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Ask Carrier for 76514 Policy
Question: What's the correct procedure code for pachymetry? Which ICD-9 codes are covered?
Texas Subscriber Answer: [...]
