Radiology Coding Alert

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When you examine the code descriptors for ophthalmic ultrasound procedures in the CPT^® code set, you’ll notice the descriptors include A- or B-scans. Each one is used to evaluate different components of the patient’s eye structures.

Read on to understand these scans and know which ophthalmic ultrasound code to assign.

Use Echoes to Image the Eye Structure

Providers perform ophthalmic ultrasounds to examine the patient’s eye structures and diagnose disorders. The procedure, also known as ocular echography, uses high-frequency sound waves to create an image of the patient’s eye without radiation or contrast material.

During the procedure, the provider applies a topical anesthesia to the patient’s eye and then places a small probe directly on the eye. The provider uses the probe to deliver sound waves, which produce the echoes needed to create the on-screen images of the patient’s eye structures.

“Ocular ultrasound is a quick, noninvasive test used to assess patients for conditions such as retinal detachment or tears, corneal opacities [scarring], and dense cataracts,” says Kristen R. Taylor, CPC, CHC, CHIAP, associate partner at Pinnacle Enterprise Risk Consulting Services. A provider performs ophthalmic ultrasounds to diagnose other conditions, as well, including intraocular tumors, vitreous (gel-like fluid that fills the eye) bleeding, and the presence of foreign bodies in the eye socket.

Know When to Report A- and B-Scans

The CPT^® code set’s Radiology chapter breaks down the Diagnostic Ultrasound codes by body area. Under the Head and Neck subsection, you’ll find the following ophthalmic ultrasound codes:

• 76510 (Ophthalmic ultrasound, diagnostic; B-scan and quantitative A-scan performed during the same patient encounter)
• 76511 (… quantitative A-scan only)
• 76512 (… B-scan (with or without superimposed non-quantitative A-scan))
• 76513 (… anterior segment ultrasound, immersion (water bath) B-scan or high resolution biomicroscopy, unilateral or bilateral)

An A-scan, or amplitude scan, ultrasound provides one-dimensional information of the eye structure. During the procedure, the patient looks straight ahead. The A-scan helps measure the tissue thickness and eye length.

B-scan ultrasounds are also known as brightness scans, and they provide cross-sectional, two-dimensional views of the patient’s eye structures. B-scans are “used for diagnosing lesions of the posterior segment of the eyeball,” Taylor says. A B-scan ultrasound is ideal for diagnosing tumors and ocular trauma, as mentioned above.

If the provider performs an ophthalmic ultrasound with a B-scan and quantitative A-scan and during a single patient encounter, then you’ll assign 76510 in the report. If the provider performs only a quantitative A-scan, then you’ll report 76511.

If you have a report that indicates the provider performed a diagnostic ophthalmic ultrasound with B-scan and nonquantitative A-scan, you’ll assign only 76512. Medicare’s National Correct Coding Initiative (NCCI) Procedure-to-Procedure edits pair 76512 with 76511. “Coders should be aware of NCCI edits on 76511/76512. The A-scan is inclusive to the procedure for the B-scan,” says Chelsea Kemp, RHIT, CCS, COC, CPC, CDEO, CPMA, CRC, CCC, CEDC, CGIC, AAPC-Approved Instructor, outpatient coding educator/auditor at Yale New Haven Health in New Haven, Connecticut.

Note that 76512 is also appropriate for a B-scan without a nonquantitative A-scan. The code descriptor makes this clear by including the phrase “with or without superimposed non-quantitative A-scan.”

Report Technical Components or the Interpretation of Results

The diagnostic ophthalmic ultrasound codes listed above consist of professional and technical components. When different healthcare providers perform the professional and technical components, you’ll need to append the appropriate procedure code with the correct modifier.

If a radiologist performs just the ophthalmic ultrasound procedure but doesn’t interpret the results, then you’ll append modifier TC (Technical component) to the appropriate ultrasound code. In this case, the radiologist performs only the technical portion of the scan.

In situations where a provider interprets the results but doesn’t perform the ultrasound, you’ll append modifier 26 (Professional component) to the appropriate CPT^® code. However, if a private practice owns the ultrasound equipment needed to perform the procedure, and a physician in the practice interprets the test results, no modifiers are needed for your report.

Correctly Code an Ophthalmic Ultrasound Procedure

Examine how you can apply ophthalmic ultrasound codes to the scenario below.

Scenario: A 65-year-old patient presents to their ophthalmologist with complaints of vision problems. The patient states they’re experiencing flashes of light and floaters in their right eye. The ophthalmologist performs a dilated eye examination and refers the patient to an outpatient radiology practice for an ophthalmic ultrasound with A-and B-scans. Following the ophthalmic ultrasound, the ophthalmologist interprets the results and diagnoses the patient with retinal detachment with a single break.

In this scenario, a radiologist performs the ophthalmic ultrasound with A- and B-scans while the ophthalmologist interprets the results. The radiologist would report 76510 appended with modifier TC since their facility owns the equipment and they performed the procedure. The ophthalmologist will report 76510 appended with modifier 26.

To report the patient’s diagnosis, you’ll search for Detachment > retina > with retinal: > break > single in the ICD-10-CM code set Alphabetic Index, where you’ll find H33.01 (Retinal detachment with single break). When you verify the code in the tabular list, you’ll see the subcategory requires a 6th character to complete the code. The patient is experiencing the retinal detachment in their right eye, so you’ll select H33.011 (Retinal detachment with single break, right eye) with 6th character 1 representing the right eye.

Mind the Guidelines for Recorded Images

According to the AMA CPT^® ultrasound guidelines, “All diagnostic ultrasound examinations require permanently recorded images with measurements,” which includes ophthalmic ultrasound examinations. The provider should also detail the measurements obtained during the procedure. “In addition to images, any measurements that would normally be found in the study must be documented, which include measurements of anatomical structures of the eye and tumor or lesion measurements,” Kemp adds.

Exception to the rule: The provider isn’t required to permanently store images if the provider performs an ophthalmic ultrasound examination where the “sole diagnostic goal is a biometric measure,” such as with:

• 76514 (… corneal pachymetry, unilateral or bilateral (determination of corneal thickness))
• 76516 (Ophthalmic biometry by ultrasound echography, A-scan)
• 76519 (… with intraocular lens power calculation)

In that case, you’ll need to ensure the physician’s written report in the patient’s medical record documents the visualization details, including lesion or abnormality measurements.