coding q & a
Coding Q & A
A-Scan coding, billing for foreign body removal and more.
By John McGreal Jr., O.D.

Question: Our office bills for A-scans on our cataract patients prior to making a referral for surgery. We're having difficulty with second eye billings and modifiers. What codes should we use?

Answer: The proper CPT code for the A-scan is 76519 (biometry by ultrasound echography, A-scan with intraocular lens power calculation). This code is subdivided into a technical component (TC) and a professional component (PC). The technical component represents the actual measuring of the length of the eye; the professional component is the calculation of the intraocular lens power and the selection of a lens implant.

Medicare considers the technical component (76519-TC) as a bilateral payment -- therefore, you'll be paid once for testing both eyes. However, the professional component is (76519-26) unilateral.

When submitting a claim for the first eye, use 76519. When submitting a claim for the second eye at a later date (assuming that eye will now have surgery), use 76519-26 with the appropriate eye modifier (LT or RT).

In this case, you'll be paid for the professional component only, as you've already collected on the technical component (76519-TC), which was a bilateral service.

The 2001 Medicare allowable for this service is $77.94.

Question: How do we bill for removing multiple foreign bodies from the cornea?

Answer: Use the CPT code 65222 (removal of foreign body, external eye: corneal, with slit lamp) when removing one or more foreign bodies. Unfortunately, there's no other code or modifier that allows you to collect more for the additional work involved in removing multiple foreign bodies. When submitting a claim for an E/M service on the same day as the foreign body removal, you should use the modifier -25 on the office visit code so that you'll be paid for both services.

The 2001 Medicare allowable for this service is $182.94.

Question: Can I bill Medicare for a comprehensive exam on the same patient more than once a year?

Answer: Medicare does examine frequency issues. If you're following a patient more frequently, you're probably assessing a chronic medical ocular condition (e.g., glaucoma, glaucoma suspect, allergic conjunctivitis, etc.). These encounters may be more accurately described by an E/M service (for example, 99212 or 99213) rather than by a comprehensive exam code (92014).

When you code for a comprehensive exam (92014), you must always initiate new diagnostic or treatment programs. If you use the same 92014 CPT code and the same ICD-9 code repetitively, there's a risk of denial of payment for frequency and an audit risk for failing to initiate a new diagnosis or treatment plans.

Question: We must bill our patients for refraction because it's a non-covered service. May we charge our patients instead of billing Medicare and waiting for a denial?

Answer: Yes. I recommend charging and collecting on refractive eye services at check-out. The Health Care Financing Administration (HCFA) claim form will show the charge for refraction, the patient payment in full and the balance as zero. Then, you can list the other codes for an examination (99xxx or 92xxx) on a separate line on the claim form along with the appropriate diagnosis codes and charges.

Dr. McGreal is center director of the Missouri Eye Institute, a VisionAmerica Co-Management Center in St. Louis. He also lectures on clinical and practice management topics.

If you have a coding question you'd like answered, send it to Terri Goshko, c/o Optometric Management, 1300 Virginia Drive, Suite 400, Ft. Washington, PA 19034. E-mail goshkotb@boucher1.com.