Marina Posted Fri 14th of June, 2013 22:18:13 PM
I billed both 76519 and 92136 to Blue Cross, however, Blue Cross only paid for code 92136 with reason: "the service is denied because it is considered to be a part of another service already performed". Is there a modifier I need to use to recieve payment on both codes?
SuperCoder Answered Mon 17th of June, 2013 13:06:57 PM
You may be tempted to report 76519 (Ophthalmic biometry by ultrasound echography, A-scan; with intraocular lens power calculation) twice in this situation. Basically, you might want to report 76519-RT and 76519-LT, or 76519-50 (Bilateral procedure). You may also be tempted to report 92136 (Ophthalmic biometry by partial coherence interferometry with intraocular lens power calculation) using bilateral modifiers.
Reality: You should not report 76519 or 92136 bilaterally, even if the ophthalmologist calculated the IOL power of both eyes. 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, TC), and the professional component (viewing and interpreting the results, 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, marked 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. Both 76519-TC and 92136-TC are marked with modifier indicator “2,” which means that the codes are considered inherently bilateral.
The work for performing the procedure on both eyes is included in the single CPT codes. Therefore, you should report 76519-TC or 92136-TC only once, whether the ophthalmologist tests one or both eyes.