Wiki 76519 with 26 modifier

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jazmine29

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Hello,
We are having a debate in my office. Apparently 76519 has been billed for the past two years with only a TC modifier, when the IOL calucalation HAS been done. Someone in the office stated that "there was a reason" we haven't been billing the professional component. I am wondering if there is anyone else out there who only bills the technical component of this service (the A-scan) and if so, why?:confused:
Thanks in advance...need help!!!
 
Are you billing the hospital component only and the doctors are billing the pro side?
If you are in a hospital based practice, the hospital bills the TC and the doc bills the 26.
 
jazmine29 said:
Hello,
We are having a debate in my office. Apparently 76519 has been billed for the past two years with only a TC modifier, when the IOL calucalation HAS been done. Someone in the office stated that "there was a reason" we haven't been billing the professional component. I am wondering if there is anyone else out there who only bills the technical component of this service (the A-scan) and if so, why?:confused:
Thanks in advance...need help!!!
Click to expand...

We own our equipment, so we bill the total component. If there is equipment we use that someone else owns, the test/procedure is performed and we interpret the results, then we bill the professional component. If we run the test/procedure for another department, then we bill the technical component and let the other department bill the professional component.

David Keown, CPC, OCS
 
dkeown said:
We own our equipment, so we bill the total component. If there is equipment we use that someone else owns, the test/procedure is performed and we interpret the results, then we bill the professional component. If we run the test/procedure for another department, then we bill the technical component and let the other department bill the professional component.

David Keown, CPC, OCS
Click to expand...

Thanks for the reply! How do you bill it when the IOL power is calculated for both eyes at the same time? I've been told that this is a code that includes the technical component for both eyes and the professional component for only one eye. Medicare however has stated that this is already considered a bilateral code. I guess my question is, do you ever need to bill this with a 50 modifier and if so does that increase your payment?
 
Thanks for the reply! How do you bill it when the IOL power is calculated for both eyes at the same time? I've been told that this is a code that includes the technical component for both eyes and the professional component for only one eye. Medicare however has stated that this is already considered a bilateral code. I guess my question is, do you ever need to bill this with a 50 modifier and if so does that increase your payment?

We just bill it the one time with no modifiers (although it is my understanding that some payers want the TC modifier when the scans are performed and then a 26 and eye modifier when the scans are read for surgery.)
 
Cpt 76519-26

In our office our doctor will examine both eyes, he will do an A scan on both eyes. We will only bill for the A scan when the patient schedules surgery. If the second eye is scheduled with in the same year we will bill for the 2nd eye using a modifier 26. I am fairly new to the practice and apparently this is the it was always done. However the doctor is performing the A scan in his own practice. Is modifier 26 necessary?
 
jazmine29 said:
Thanks for the reply! How do you bill it when the IOL power is calculated for both eyes at the same time? I've been told that this is a code that includes the technical component for both eyes and the professional component for only one eye. Medicare however has stated that this is already considered a bilateral code. I guess my question is, do you ever need to bill this with a 50 modifier and if so does that increase your payment?
Click to expand...

CPT Code 76514: Ophthalmic ultrasound, diagnostic, corneal pachymetry, UNILATERAL or BILATERIAL

-26/-TC:
For the -TC bill once weather testing one eye or both
For the -26 bill per eye (ie. 76514-26RT)

Hope this helps,
Rebecca
 
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