Tag Archives | Intraocular Lens

CMS Reassigns HCPCS Code Q1003 to a Deleted Payment Indicator: Q&A With Cristina Bentin of Coding Compliance Management

By Rob Kurtz | April 20, 2011 CPT copyright 2010 American Medical Association. All rights reserved. CPT is a registered trademark of the American Medical Association. Cristina Bentin, CCS-P, CPC-H, CMA, is president of Coding Compliance Management. Q: Since April 1, our clearinghouse has been rejecting claims with NTIOL Q1003. We understand that no additional reimbursement was to […]

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A-Scans: Report Denial Proof 76511 Claim With Accurate Bilateral, Modifier Reporting

One of the most common procedures in ophthalmology is A-scan ultrasound biometry, which is associated with some of the most uncommon coding problems.

According to CPT, A-scans — 76511, 76516, and 76519 — are the shortened names for amplitude modulation scans, “one-dimensional ultrasonic measurement procedures,” notes Maggie M. Mac, CPC, CEMC, CHC, CMM, ICCE, Director, Best Practices-Network Operations at Mount Sinai Hospital in New York City.

Ophthalmologists use 76511 (Ophthalmic ultrasound, diagnostic; quantitative A-scan only) to diagnose eye-related complications such as eye tumors, hemorrhages, retinal detachment, etc.

Physicians use 76516 (Ophthalmic biometry by ultrasound echography, A-scan) to measure the axial length of the eye in preparation for cataract surgery.

And 76519 (Ophthalmic biometry by ultrasound echography, A-scan; with intraocular lens power calculation) allows ophthalmologists to determine the intraocular lens calculation prior to cataract surgery only.

Typically, most A-scans are performed bilaterally. However, circumstances may only require the physician to perform a unilateral scan.

Each A-scan code has separate requirements when billed bilaterally. For example, payers consider 76511 unilateral, requiring the use of modifiers LT/RT/50 (Left side/Right side/Bilateral procedure) or the units value of “2.”

But 76516 is inherently bilateral, so you shouldn’t append modifier 50 to it.

For CPT Code 76519, some payers (including Medicare) consider only the technical component bilateral whereas the professional component is unilateral.

Some non-Medicare payers, on the other hand, want you to bill globally and don’t typically divide the professional and technical components, so you must determine which insurance company you are coding for and what its policy is for billing A-scans.

Medicare carriers for Part B services have published articles specifying their preference to report a bilateral service with a single line item with modifier 50 and one unit of service, whereas [some] non-Medicare payers prefer reporting bilateral services with two line items…

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Pre-Cataract Surgery Coding Myths You Should Bust

Improperly coding IOL Masters or A-scans can cost your practice $30 per patient.

Calculating intraocular lens power for patients facing cataract surgery has gotten more precise as A-scan and IOL Master technology has advanced. But to make sure your practice is getting fairly reimbursed each time, you need to understand the bilateral rules for 76519 and 92136.

Could one of these myths be damaging your claims?

Include Bilateral and Unilateral Components in Global Code

Myth: If the ophthalmologist calculates IOL power in both eyes, you should report 76519 (Ophthalmic biometry by ultrasound echography, A-scan; with intraocular lens power calculation) or 92136 (Ophthalmic biometry by partial coherence interferometry with intraocular lens power calculation) twice (e.g., 76519-RT and 76519-LT, or 76519-50).

Reality: You should not report 76519 or 92136 with modifier 50 even if the ophthalmologist calculated the IOL power of both eyes, warns Maggie M. Mac, CPC, CEMC, CHC, CMM, ICCE, Director, Best Practices-Network Operations at Mount Sinai Hospital in New York City. To understand why, it’s helpful to know how Medicare’s Physician Fee Schedule values the procedures.

As it does with many other diagnostic tests, CMS divides the A-scan (76519) and the IOL Master (92136) into two components. The technical component (the actual performing of the test) is denoted with modifier TC, and the professional component (viewing and interpreting the results) is denoted with modifier 26.

For most procedures, the technical and professional components have the same bilateral status – for example, 92250-TC and 92250-26 (Fundus photography with interpretation and report) are both considered inherently bilateral, denoted with modifier indicator “2” on the fee schedule. The reimbursement for all components of 92250 is based on both eyes being tested.

Exception: For both 76519 and 92136, the technical component has a different bilateral status from the professional component. You can find…

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Cataract Surgery Coding Skill Builder

Determine ‘planned or unplanned’ before separately coding vitrectomy.
With several possible surgical treatments for cataract procedures, which you probably code more often than any other surgery, there’s a lot of room for error – with over $890 at stake for complex cataract procedures in 2009.
Use these tricky scenarios as a guide through some of the most [...]

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Cataract Surgery Coding: When Optometrist Provides Postop Care

We’ve got the modifier you need when the ophthalmic surgeon passes the baton.
Question: An ophthalmic surgeon performs cataract surgery, and then turns the patient over to the optometrist for postoperative management only. How should I code between the two providers? Do I need a modifier?
Answer: If the ophthalmic surgeon turns the patient over to the [...]

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  3. Cataract Removal Eye-Opener: 66984CPT 66984 is the number-one procedure performed in ASCs, according…
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Coding News Coding News – News about Coding 2009-11-30 23:00:02

Split Postoperative Cataract Care

Question: An ophthalmic surgeon performs cataract surgery, and then turns the patient over to the optometrist for postoperative management only. How should I code between the two providers? Do I need a modifier?
Washington Subscriber
Answer: If the ophthalmic surgeon turns the patient over to the optometrist for all 90 days of postoperative care, the optometrist will report 66984 [...]

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  3. Medical Coder’s Modifier 25 Checklist Append 25 with the greatest of ease … Appending…
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