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February 2005

Savvy Coder: Coding & Reimbursement
Competent Coding for Ophthalmic Radiology Services:
Part I
By Sue Vicchrilli, COT, OCS, Academy Coding Executive, and
Michael X. Repka, MD, OCS, Secretary for Federal Affairs

When you’re looking through this year’s edition of Current Procedural Terminology, you’ll see that a dot (●) flags each new CPT code and a triangle (▲) flags each updated descriptor. In the radiology section of CPT 2005, the following changes to ophthalmic codes went into effect last month.

CPT 76510
A new code, ● CPT 76510 ophthalmic ultrasound, diagnostic; B-scan and quantitative A-scan performed during the same patient encounter, is to be used when both a quantitative A-scan and B-scan are performed simultaneously.  This code is not used when reporting findings from an instrument that provides an incidental A-scan. In most cases, two different instruments are required or at least two different hand pieces. The A-scan included in this scan would most often be done to quantify the height or internal reflectivity of retinal or choroidal lesions. Historically, there has been confusion among payers over what constituted this extra A-scan service.

Suppose the ophthalmologist or a member of staff performs the tests and the ophthalmologist also owns the equipment? In that case, use code 76510–eye modifier or, when bilaterally medically indicated, 76510–50.

Payment is typically $170.92 per eye. If you provide only the technical component, then code 76510-TC ($85.27). If you provide only the professional interpretation, then code 76510-26–eye modifier ($85.65).

The National Correct Coding Initiative (NCCI) bundles CPT codes 76511 and 76512 with 76510 so that only the payment for 76510 is allowed.

CPT code 76510 is not to be used when measuring the axial length of the eye for an IOL. The correct code continues to be CPT code 76519 or 92136, depending on the technology used for the assessment.

▲ CPT 76511 and ▲ CPT 76512
The addition of code 76510 meant that descriptors for two other codes had to be changed.

▲ 76511 Ophthalmic ultrasound, echography, diagnostic; quantitative A-scan only, with amplitude quantification. Billing guidelines follow the pattern for code 76510. The global allowable is $131.50; the technical component’s (TC) typical allowable is $79.58; and the professional component’s (26) allowable is $51.92. A quantitative A-scan provides a study similar to an EKG reading, with valleys and peaks. It measures and quantifies the echographic qualities of different tissues. It also is used to identify tumors or melanomas.

▲ 76512 Ophthalmic ultrasound, diagnostic; contact B-scan (with or without superimposed non-quantitative A-scan) simultaneous A-scan). The billing guidelines follow the pattern for code 76511. The global allowable is $124.68; the technical component’s (TC) typical allowable is $72.38; and the professional component’s (26) allowable is $552.30. The CMS does not specify the level of all three of these codes, due to the fact that they are usually performed by a physician.

As with all codes in the radiology section of CPT, the ordering physician’s UPIN number must be provided in Box 17A of the HCFA 1500 form.

Also New in 2005

  • The Medicare patient deductible has increased from $100 to $110.
  • The NCCI no longer bundles CPT code 67038 vitrectomy with epiretinal membrane stripping and CPT code 67039 focal endolaser photocoagulation with CPT code 66982 complex cataract surgery and CPT code 66984 cataract extraction with IOL.
  • For other news, order the CD-ROM of AAOE’s 2005 recent audioconference(