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...