Denice, This is useful/comprehensive info! Would be great if you could also post it on the Forums on the OPS' new and improved website. Thanks for posting, bob -----Original Message----- From: optimal-bounce@xxxxxxxxxxxxx [mailto:optimal-bounce@xxxxxxxxxxxxx] On Behalf Of CPMC Ophthalmic Diagnostic Center Sent: Thursday, March 15, 2012 12:50 PM To: optimal@xxxxxxxxxxxxx Subject: [optimal] From Denice re Billing and Coding for Ophthalmic Ultrasound Here are the various codes for ultrasound. Rhonda is correct. In addition to the proper CPT code, each CPT code is only "eligible" for certain diagnosis's, not unlike photography. Will send correct ICD.9 codes in separate eMail. Denice DIAGNOSTIC OPHTHALMIC ULTRASOUND BILLING Definitions: A mode implies a one-dimensional ultrasonic measurement M-mode implies a one-dimensional ultrasonic measurement Procedure with movement of the trace to record amplitude and velocity of moving echo-producing structures B-scan implies a two-dimensional ultrasonic scanning procedure With a two-dimensional display Real-time scan implies a two dimensional ultrasonic scanning Procedure with a display of both two-dimensional structure and motion with time ( kinetic scanning, i.e. movies ) CPT Codes 76510 Ophthalmic ultrasound, diagnostic, B-scan, and quantitative A-scan performed during the same patient visit Clinical name: Diagnostic B-scan AND Standardized A-scan( used typically in a tumor setting, when you want to view the lesion with B-scan AND quantify its internal nature by standardized A-scan 76511 Ophthalmic ultrasound, echography, diagnostic: quantitative A-scan only Clinical name: Standardized A-Scan 76512 Ophthalmic ultrasound, diagnostic; B-scan ( with or without superimposed non-quantitative A-scan Clinical name: Diagnostic B-Scan 76513 Immersion ( water bath) diagnostic B-scan Clinical name: Immersion B-scan 76516 Ophthalmic biometry by ultrasound echography Clinical name: Axial Eye Length Biometry by echography 92136 Ophthalmic biometry by partial coherence interferometry with IOL power calculation Clinical name: Axial Eye Length Biometry by IOL master Remember, you cannot bill for Echographic Biometry and Optical Biometry on the same day or for the same patient. You may PERFORM both, and bill for one or the other....... When doing both eyes on the same day, physician may bill for the professional component for each eye at the time of surgery. The technical component is billable and payable only once. If biometry has been done elsewhere, or MD feels it needs to be repeated for medical necessity, you may bill for biometry more than once in a year. Otherwise, only payable once- considered a lifetime procedure 76519 Ophthalmic Biometry by ultrasound echography with IOL calculation Clinical name: Axial Eye Length Biometry with IOL calculation. ( This is the code used unless you are only measuring the eye to know it's length and NOT implanting an IOL ) 76519 Ophthalmic ultrasonic foreign body localization Clinical name: Diagnostic B-scan. ( this is a specialty code used when looking for an intraocular foreign body. This code assumes you need to spend extra time with the B-scan looking for a foreign body in the eye ) Denice Barsness, CRA, COMT, ROUB, CDOS, FOPS Ophthalmic Diagnostic Center CPMC Department of Ophthalmology 2100 Webster Street Suite 212 San Francisco CA 94115 (415) 600-3937 FAX (415) 600-6563 -----Original Message----- From: optimal-bounce@xxxxxxxxxxxxx [mailto:optimal-bounce@xxxxxxxxxxxxx] On Behalf Of sandor ferenczy Sent: Friday, March 09, 2012 2:46 PM To: optimal@xxxxxxxxxxxxx Subject: [optimal] Re: Billing for UBM as Rhonda said, make sure they are billing with an appropriate diagnosis code. the AAO's ophthalmic coding coach book is a big help with that. we keep a copy in our clinic. https://secure.aao.org/EbusPPROD/AcademyStore/ProductDetail/tabid/55/ProductId/24617/Default.aspx sandor Sandor Ferenczy, CRA, OCTc Ophthalmic Photographer Ocular Oncology Service Wills Eye Institute 840 Walnut Street, 14th Floor Philadelphia, Pa 19107 www.fighteyecancer.com On Fri, Mar 9, 2012 at 3:44 PM, Cheek, Scott <scheek@xxxxxxxxxxxx> wrote: > I am writing on behalf of a customer who claims his local Medicare > providers will not reimburse him for UBM CPT 76513. He is located in Albany, > NY. > What I would like to know is if there are any others out there > billing for UBM in this region successfully or if anyone else has > experienced this denial. > > > > > > Scott Cheek > > Ultrasound Division Manager > > Accutome, Inc > > 3222 Phoenixville Pike > > Malvern, Pa 19355 > > 800-979-2020 > > 610-889-0200 > > Fax: 610-889-3233 > > www.accutome.com > > > >