Ophthalmology and Optometry Coding Alert

Watch out for inconsistencies among your carriers A-scans are some of the most common procedures performed in ophthalmology offices, but coding them can present you with some uncommon problems.
 
According to CPT, A-scans - 76511, 76516 and 76519 - are the shortened names for A-mode scans, "one-dimensional ultrasonic measurement procedures." Ophthalmologists use 76511 (Ophthalmic ultrasound, echography, diagnostic; A-scan only, with amplitude quantification) to diagnose eye-related complications such as eye tumors, hemorrhages, retinal detachment, etc. Physicians use 76516 (Ophthalmic biometry by ultrasound echography, A-scan) to measure the axial length of the eye in preparation for cataract surgery. And 76519 (Ophthalmic biometry by ultrasound echography, A-scan; with intraocular lens power calculation) is used to determine the intraocular lens calculation prior to cataract surgery only.

Unilateral A-Scans


Not all A-scans are bilateral: Each A-scan code has separate requirements when billed bilaterally. For example, 76511 is considered unilateral, requiring the use of modifiers -LT/-RT/-50 (Left side/Right side/Bilateral procedure) or the units value of "2."
 
But 76516 is considered inherently bilateral, so you shouldn't append modifier -50 to it.
 
Beware: Some carriers consider only the technical component bilateral. Some carriers (including Medicare) have determined the technical component of one of the A-scan codes to be bilateral, and the professional component to be unilateral.
 
Some non-Medicare carriers, on the other hand, want you to bill by line and don't typically divide the professional and technical components, so it is imperative that you determine which carrier you are coding for and what its policy is for billing A-scans. Master 76519 for Medicare Medicare's payment policy for 76519 is notoriously confusing. And because both A-scans and cataract surgery constitute a large part of a general ophthalmologist's practice, it's important to know how to bill for 76519.
 
First, an ophthalmologist must perform this procedure before cataract surgery for reimbursement. When you submit claims for ophthalmic biometry - CPT codes 76516 and 76519 - to carriers, you should document the presence of a cataract and your plan for removing it. Make sure there is a written order by the physician in the patient's chart for the A-scan.
 
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 intention of performing cataract surgery.
 
Billing myth: Code 76519 must be billed the date the surgical procedure (typically 66984, Extracapsular cataract removal ...) is performed, and if the surgery doesn't take place, the test isn't billable. In the early 1990s, some carriers did want the billing date for the A-scan to be the same date as the cataract procedure; this is no longer true.
 
If the surgical procedure is not performed, the test is still billable based [...]