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Coding for 92136 & 76519(Ophthalmology)

  1. Default Coding for 92136 & 76519(Ophthalmology)
    Medical Coding Books
    Wanting to confirm the correct way to code for IOL power calculations and A-scans and when to use modifiers -TC & -26. In school, I understood that -TC was used if the technical component of a procedure was sent out to be done. Our docs have their own equipment to perform these procedures and they do their own interpretations. I've been reading an Optometry Coding & Billing Alert and am a little confused as to the correct way to code these procedures. The Alert states that "If you calculate IOL power in both eyes, code the technical & professional components separately. Is this correct? For example:
    92136-TC for the bilateral technical component
    92136-26-50 for the bilateral professional component

    The other issue I'm not clear on is if an A-Scan (76519) is performed on one eye and an IOL power calculation is performed on the other.

    The example in the Alert states:"You perform the technical portion of an A-scan on the left eye, but dense cataracts prevent you from getting a viable result from the right eye. You perform an IOL Master on the right eye and calculate IOL power for the right eye. You can only report one unit of 92136-RT.

    What confuses me is that I'm also told that you can't code 76519 & 92136 together since they are in a mutually exclusive bundle, and if you report both codes, Medicare carriers will only pay you for 92136. But if you have to perform both in order to get viable calculations for both eyes, what do you do?

    Hope someone can help me out.

    Thank you.
    Derinda Green
    Last edited by didigirl; 09-23-2009 at 01:56 PM.

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