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Question: I have an operative note that mentions the physician performed a bilateral intraocular lens (IOL) calculation procedure for a patient with Medicare. How can I report this procedure?

Mississippi Subscriber

Answer: Reporting bilateral IOL calculations may seem straightforward, but it can be tricky and you could face a claim denial if reporting the procedure isn鈥檛 done correctly. Luckily, Revenue Cycle Insider has the information you need to improve your chances of a claim approval.

The CPT^庐 code set includes 76519 (Ophthalmic biometry by ultrasound echography, A-scan; with intraocular lens power calculation) and 92136 (Ophthalmic biometry by partial coherence interferometry with intraocular lens power calculation) for IOL calculations, but to report either procedure bilaterally, you鈥檒l need to report the components separately.

The Centers for Medicare & Medicaid Services (CMS) divides 76519 and 92136 into the technical component and the professional component, much like the agency does with other diagnostic tests. You鈥檒l report each procedure鈥檚 technical component with modifier TC (Technical component) and the professional component with modifier 26 (Professional component).

According to the Medicare Physician Fee Schedule database, each component has different bilateral statuses. For example, 76519-TC and 92136-TC have modifier indicator 鈥�2,鈥� which means each code鈥檚 technical component is considered inherently bilateral. Therefore, you can report the technical component of the CPT^庐 codes 鈥� 76519-TC or 91236-TC 鈥� only once regardless of whether the provider tests one or both eyes.

On the other hand, the professional components for 76519 and 91236 are marked with modifier indicator 鈥�3,鈥� which means the codes鈥� professional component is unilateral.

Usually, the ophthalmologist will perform the scan on both eyes, but only calculate IOL power for the eye being operated on. If, however, the ophthalmologist needs to calculate IOL power in both eyes, such as in the situation you presented, you would assign the following codes and modifiers:

• 92136-TC to report the bilateral technical component
• 92136-26-50 to report the bilateral professional component

Appending modifier 50 (Bilateral procedure) for 92136鈥檚 professional component shows Medicare that the physician performed the usually unilateral IOL calculation on both eyes.

Important: Of course, you should review your individual payer preferences to check if the payer wants you to use modifier 50 or the RT (Right side)/LT (Left side) modifiers to report the bilateral professional component.

Mike Shaughnessy, BA, CPC, Development Editor, AAPC