Ophthalmology and Optometry Coding Alert

One of the most commonly reported scan codes is 76519, but before you can calculate your expected reimbursements for this A-scan, you'd better be sure your claim meets the requirements outlined by CMS. Use the answers to these frequently asked questions to clear up any confusion you may have about billing 76519 (Ophthalmic biometry by ultrasound echography, A-scan; with intraocular lens power calculation). What Kind of Documentation Do I Need When I Report Claims for 76519? Diligent, detailed documentation is always a good idea when submitting any claim to an insurance company, but when you are submitting a claim for 76519, it is crucial. When claims for ophthalmic biometry CPT codes 76516 and 76519 are submitted to carriers, you should document the presence of a cataract and the plan for its removal. The first thing you should check is that there is a written order by the physician in the patient's chart for the A-scan, says Rita Knapp, CPC, coding specialist with Whitson Abrams Vision and Laser Centers in Indianapolis. Clearly convey to the carrier, especially if the carrier is Medicare, which only covers 76519 when it is performed in conjunction with cataract surgery, that the A-scan was performed with the intent to perform cataract surgery to avoid denials or payment postponement, says Brenda Parker, CPC, assistant administrator for River Cities Ophthalmology in Fort Madison, Iowa. Your documentation may also indicate the need for a secondary implant.

"Generally we perform the A-scan the same day as the preoperative evaluation, and that is when we bill them." If you perform the A-scan the same day as the preoperative evaluation, document that there is an intent to perform cataract surgery, she tells coders. As long as the A-scan was ordered when the patient elected to have surgery, you have documented intent, she adds. Although Parker's instructions sound easy, many charts are missing the physician's order for the A-scan along with the laboratory tests that are going to be performed, says Raequell Duran, president of Practice Solutions in Santa Barbara, Calif. "Not only is the order required to substantiate medical necessity, but the order of testing services contributes to the level of evaluation and management service." What Are the Rules for Billing 76519 Bilaterally? Billing bilateral A-scans with intraocular lens (IOL) power calculations is tricky because there is both a professional and a technical component inherent in code 76519. When ophthalmologists use A-scans to measure the lens prior to cataract surgery, for example, you have to be careful to code and bill keeping in mind that 76519 has both a technical component and a professional component which requires mastering modifiers -26 (Professional component) and -TC (Technical component). When you bill for a testing [...]