Results 1 to 8 of 8

76519 with 26 modifier

  1. #1
    Default 76519 with 26 modifier
    Exam Training Packages
    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?
    Thanks in advance...need help!!!

  2. Default
    are you billing Medicare or another payer?

  3. Default
    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.

  4. #4
    Location
    Lexington Kentucky Chapter
    Posts
    105
    Default
    Quote Originally Posted by jazmine29 View Post
    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?
    Thanks in advance...need help!!!
    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

  5. #5
    Default
    Quote Originally Posted by dkeown View Post
    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
    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?

  6. #6
    Location
    Lexington Kentucky Chapter
    Posts
    105
    Default
    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.)

  7. Default 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?

  8. #8
    Location
    dont really have one...live 130 miles from the closest one
    Posts
    19
    Default
    Quote Originally Posted by jazmine29 View Post
    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?
    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

    Rebecca Pollock, CPC

Similar Threads

  1. Replies: 2
    Last Post: 09-18-2015, 02:17 PM
  2. 76519/92136
    By RebKayTay in forum Ophthalmology/Optometry
    Replies: 0
    Last Post: 12-23-2014, 09:27 AM
  3. Ophthalmic Ultrasounds/ Echos 76510-76519
    By lindaskin in forum Ophthalmology/Optometry
    Replies: 1
    Last Post: 10-19-2010, 03:02 PM
  4. Coding for 92136 & 76519(Ophthalmology)
    By didigirl in forum Ophthalmology/Optometry
    Replies: 0
    Last Post: 09-23-2009, 02:53 PM
  5. Coding for 92136 & 76519(Ophthalmology)
    By didigirl in forum Medical Coding General Discussion
    Replies: 0
    Last Post: 09-23-2009, 02:53 PM

Posting Permissions

  • You may not post new threads
  • You may not post replies
  • You may not post attachments
  • You may not edit your posts
  •  
Enjoying Our Forums?

AAPC forums are a benefit of membership. Joining AAPC grants you unlimited access, allowing you to post questions and participate with our community of over 150,000 professionals.

Join Now Continue Reading Without Full Access

Already a Member?

Login

Close Message

In addition to full participation on AAPC forums, as a member you will be able to:

  • Access to the largest healthcare job database in the world.
  • Join over 150,000 members of the healthcare network in the world.
  • Be a part of an industry leading organization that drives the business side of healthcare.
  • Save anywhere from 10%-50% with exclusive member discounts on courses, books, study materials, and conferences.
  • Access to discounts at hundreds of restaurants, travel destinations, retail stores, and service providers. AAPC members also have opportunities to save on heath, life, and liability insurance.
  • Become a member of a local chapter and attend regular meetings.