Don't have a TCI SuperCoder account yet? Become a Member >>

Regular Price: $24.95

Ask An Expert Starting at $24.95
Have a medical coding or compliance question? Don’t sacrifice your valuable time to endless research. Choose Ask an Expert to get clear answers from the TCI SuperCoder team. And here’s a tip for the budget-conscious: Select the 12-question pack to get the best rate per question!

Browse Past Questions By Specialty

+View all

place of service code for 92136/76519 26 modfier

Donna Posted Thu 27th of December, 2012 17:08:22 PM

We have always billed the technical portion on the day of the testing and the interp on the day of the surgery for whichever eye. We have always billed with place of service SDC as the Dr is there to do the surgery. We just had a consultant in and they said to do the place of service as the office not the SDC. What are your thoughts? Have we been billing incorrectly for all this time?

SuperCoder Answered Mon 07th of January, 2013 22:19:41 PM

Reporting the technical and professional components of this procedure is a little tricky. You may be tempted to report 76519 (Ophthalmic biometry by ultrasound echography, A-scan; with intraocular lens power calculation) with modifiers

RT (Right side) and LT (Left side), or modifier 50 (Bilateral procedure). You may also be tempted to report 92136 (Ophthalmic biometry by partial coherence interferometry with intraocular lens power calculation) using the bilateral modifiers.

Reality: You should not report 76519 or 92136 bilaterally, even if the ophthalmologist calculated the intraocular (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 diagnostic tests, CMS divides the A-scan (76519) and the IOL Master (92136) into two components: the technical component (the actual perform-ing of the test, modifier TC), and the professional com-ponent (viewing and interpreting the results, 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, designated 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 than the professional component. Both 76519-TC and 92136-TC are designated with modifier indicator "2," which means that the technical components of these codes are considered inherently bilateral. But 76519-26 and 92136-26 are designated with modifier indicator "3," which means that Medicare payers will not apply the usual payment adjustment for bilateral procedures.

The technical 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.

Check with your local carrier to determine how the technical and professional components of these services should be reported. Here are two examples:

Example 1:

76519-26-RT

76519-26-LT

76519-TC

Example 2:

76519-26-50

76519-TC

Ophthalmic Biometry (CPT Codes 76519 and 92136): Valid Places of Service

Effective immediately, CGS will allow ophthalmic biometry only in the following places of service:

11 (office)
21 (inpatient hospital) - NOTE: Only the interpretation is payable in this place of service
22 (outpatient hospital) - NOTE: Only the interpretation is payable in this place of service
24 (ambulatory surgical center)
49 (independent clinic)
This change applies to the following CPT codes:

CPT code 76519: ophthalmic biometry by ultrasound echography, A-scan with intraocular lens power calculation
CPT code 92136: ophthalmic biometry by partial coherence interferometry with intraocular lens power calculation

Related Topics