Ophthalmology and Optometry Coding Alert

Skipping these 26 and TC rules could be costing you $30 per patientIn 2005, Medicare paid ophthalmologists more than $10 million for performing two IOL calculation procedures. Our experts show you how to make sure you get your fair share.Calculating intraocular lens (IOL) implant strength for patients facing cataract extraction is a straightforward part of most ophthalmologists' workloads -- but the rules for coding and billing these procedures are far from simple. When a patient is facing cataract extraction with IOL insertion, an ophthalmologist must often perform either an A-scan or an IOL Master measurement to determine the type and power the IOL should be.Medicare divides these procedures into technical and professional components and has set rules about which components you can -- and cannot -- report bilaterally. And if you're sharing the work with an optometrist, your coding task is even more complex.Include Both Eyes in TCThe IOL Master (92136, Ophthalmic biometry by partial coherence interferometry with intraocular lens power calculation), or optical coherence biometry (OCB), is becoming the gold standard for IOL measurements. OCB is a more advanced way of calculating IOL power than the A-scan (76519, Ophthalmic biometry by ultrasound echography, A-scan; with intraocular lens power calculation). But there are cases (such as mature cataracts) that require ultrasound echography instead of OCB.Key: Medicare divides both 76519 and 92136 into two components, says Judy Seymour, ACS-OH, coder and biller for Eye Associates of the South in Biloxi, Miss. Each code contains a technical component, marked by appending modifier TC (Technical component), and a professional component, which you indicate with modifier 26 (Professional component).The Medicare Physician Fee Schedule assigns CPT codes modifier indicators that determine how Medicare reimburses codes that coders report bilaterally. Snag: The professional component of the IOL Master has a different bilateral status than the technical component. The same is true for the components of the A-scan procedure.The fee schedule marks the technical components of both 76519 and 92136 with modifier indicator "2." That indicator means that the code already specifies a bilateral procedure, says Melissa Woods, CPC, coder and biller with Advanced Eye Care in Alexandria, Va.The single CPT codes include the work for performing the procedure's technical component on both eyes -- you should report 76519-TC or 92136-TC only once, whether the ophthalmologist examines one or both eyes. Ophthalmologists typically perform the procedure's technical component (the actual measurement of the eye) on both eyes at the same time.Consider 26 Inherently UnilateralOn the other hand, the fee schedule marks the professional components (76519-26 and 92136-26) with modifier indicator "3," which means that the codes are inherently unilateral.Although the ophthalmologist performs the technical component on both eyes, he may calculate the IOL power only for the eye that will receive [...]