Ophthalmology and Optometry Coding Alert

Sharpen your skills, unravel the bilateral rules and get fully reimbursed

One of ophthalmology's most-performed procedures also happens to be one of the most confusing to code properly. Take this quiz to see if your coding for A-scans meets the high standards of your Medicare Part B or private insurer.

Hint: You can find many of the answers in "Coding IOL Masters and A-Scans Together? Read This First" in the February 2005 Ophthalmology Coding Alert. Question 1: What does Medicare consider included in the global package for 76519 (Ophthalmic biometry by ultrasound echography, A-scan; with intraocular lens power calculation)?

A: The professional component and the technical component performed on both eyes
B: The professional component and the technical component performed on one eye
C: The professional component performed on one eye and the technical component performed on both eyes
D: The professional component performed on both eyes and the technical component performed on one eye Question 2: The ophthalmologist performs an A-scan prior to cataract surgery on the patient's left eye. He performs the complete test on both eyes and calculates the IOL power in the left eye. The correct coding is:

A: 76519
B: 76519-50
C: 76519-TC-50 and 76519-26-LT
D: 76519-52 Question 3: The ophthalmologist performs an A-scan on both eyes, calculating the IOL power on both sides. The correct coding is:

A: 76519
B: 76519-26-50 and 76519-TC
C: 76519-26 and 76519-TC-50
D: 76519 x 2 Question 4: While performing an IOL master (92136, Ophthalmic biometry by partial coherence interferometry with intraocular lens power calculation), the ophthalmologist performs the technical component on the right eye, with a viable result. However, he cannot get a viable result from the left eye, and must use an A-scan there. He calculates IOL power for one eye. The correct coding is:

A: 92136 and 76519
B: 92136-TC-52-RT, 76519-TC-52-LT and 92136-26
C: 92136 and 76519-26
D: 92136 Question 5: The ophthalmologist performs an A-scan prior to surgery in a patient's left eye. Six months later, the patient returns for an A-scan on his right eye. The correct coding for the right eye is:

A: 76519-RT
B: 76519-26-RT
C: 76519-52
D: 76519-26 and 76519-TC-52
Question 1: C. The professional and technical components of 76519 have different bilateral-surgery indicators, says Amanda Morris, coding specialist for Siskiyou Eye Center of Ashland, Ore.

Medicare views the technical component as inherently bilateral (indicator 2), meaning that the payment for 76519-TC (Technical component) is based on the procedure being performed bilaterally. However, since the ophthalmologist may measure the IOL strength in just one eye, 76519-26 (Professional component) is unilateral (indicator 3)--the payment includes the professional component performed on only one eye. Question 2: A. Based on the bilateral rules explained above, one unit of 76519 represents the work done by performing the technical component on both sides and the professional component (IOL [...]