Print | ShareCPT Code: 76516 Region: 37
States covered: General guidelines if your state does not have a local coverage determination
Title: Ophthalmic Biometry by A-scan
Category
Ophthalmic Ultrasound
Description
Ophthalmic biometry by ultrasound echography, A-scan
This Medicare carrier does not have a local coverage determination (LCD) for an ophthalmic biometry by A-scan. The policy presented is a sample and it is provided as a reference guide only and should not be construed as policy for your current Medicare carrier.
There are two methods used for intraocular lens power calculation:
1. A-Scan Ultrasound Ophthalmic Biometry:
Ophthalmic A-scan biometry by ultrasound echography is performed through the optical axis of the eye to determine the power of an intraocular (IOL) lens implant. The technical portion of ophthalmic biometry is usually performed in both eyes at the same setting.
2. Non-Ultrasound Ophthalmic Biometry:
Optical coherence biometry (OCB) utilizes partial coherence interferometry for measuring axial length (biometry) and for intraocular lens power calculation when planning for cataract surgery. OCB also measures the corneal curvature and anterior chamber depth. The technical portion is usually performed in both eyes at the same visit.
Ophthalmic Biometry with intraocular lens power calculation is indicated for patients who will undergo cataract extraction with lens implantation.
- Identification and/or follow-up for cataract
- Identification and/or follow-up for aphakia and other disorders of the lens
- Post-operative management of ocular surgery
ICD-10 Diagnosis Codes
| ICD-10 Codes | Description |
|---|---|
| E10.36 | Type 1 diabetes mellitus with diabetic cataract |
| E11.36 | Type 2 diabetes mellitus with diabetic cataract |
| E13.36 | Other specified diabetes mellitus with diabetic cataract |
| H25.011 | Cortical age-related cataract, right eye |
| H25.012 | Cortical age-related cataract, left eye |
| H25.013 | Cortical age-related cataract, bilateral |
| H25.031 | Anterior subcapsular polar age-related cataract, right eye |
| H25.032 | Anterior subcapsular polar age-related cataract, left eye |
| H25.033 | Anterior subcapsular polar age-related cataract, bilateral |
| H25.041 | Posterior subcapsular polar age-related cataract, right eye |
| H25.042 | Posterior subcapsular polar age-related cataract, left eye |
| H25.043 | Posterior subcapsular polar age-related cataract, bilateral |
| H25.11 | Age-related nuclear cataract, right eye |
| H25.12 | Age-related nuclear cataract, left eye |
| H25.13 | Age-related nuclear cataract, bilateral |
| H25.21 | Age-related cataract, morgagnian type, right eye |
| H25.22 | Age-related cataract, morgagnian type, left eye |
| H25.23 | Age-related cataract, morgagnian type, bilateral |
| H25.811 | Combined forms of age-related cataract, right eye |
| H25.812 | Combined forms of age-related cataract, left eye |
| H25.813 | Combined forms of age-related cataract, bilateral |
| H25.89 | Other age-related cataract |
| H25.9 | Unspecified age-related cataract |
| H26.001 | Unspecified infantile and juvenile cataract, right eye |
| H26.002 | Unspecified infantile and juvenile cataract, left eye |
| H26.003 | Unspecified infantile and juvenile cataract, bilateral |
| H26.011 | Infantile and juvenile cortical, lamellar, or zonular cataract, right eye |
| H26.012 | Infantile and juvenile cortical, lamellar, or zonular cataract, left eye |
| H26.013 | Infantile and juvenile cortical, lamellar, or zonular cataract, bilateral |
| H26.031 | Infantile and juvenile nuclear cataract, right eye |
| H26.032 | Infantile and juvenile nuclear cataract, left eye |
| H26.033 | Infantile and juvenile nuclear cataract, bilateral |
| H26.041 | Anterior subcapsular polar infantile and juvenile cataract, right eye |
| H26.042 | Anterior subcapsular polar infantile and juvenile cataract, left eye |
| H26.043 | Anterior subcapsular polar infantile and juvenile cataract, bilateral |
| H26.051 | Posterior subcapsular polar infantile and juvenile cataract, right eye |
| H26.052 | Posterior subcapsular polar infantile and juvenile cataract, left eye |
| H26.053 | Posterior subcapsular polar infantile and juvenile cataract, bilateral |
| H26.061 | Combined forms of infantile and juvenile cataract, right eye |
| H26.062 | Combined forms of infantile and juvenile cataract, left eye |
| H26.063 | Combined forms of infantile and juvenile cataract, bilateral |
| H26.09 | Other infantile and juvenile cataract |
| H26.101 | Unspecified traumatic cataract, right eye |
| H26.102 | Unspecified traumatic cataract, left eye |
| H26.103 | Unspecified traumatic cataract, bilateral |
| H26.111 | Localized traumatic opacities, right eye |
| H26.112 | Localized traumatic opacities, left eye |
| H26.113 | Localized traumatic opacities, bilateral |
| H26.121 | Partially resolved traumatic cataract, right eye |
| H26.122 | Partially resolved traumatic cataract, left eye |
| H26.123 | Partially resolved traumatic cataract, bilateral |
| H26.131 | Total traumatic cataract, right eye |
| H26.132 | Total traumatic cataract, left eye |
| H26.133 | Total traumatic cataract, bilateral |
| H26.20 | Unspecified complicated cataract |
| H26.211 | Cataract with neovascularization, right eye |
| H26.212 | Cataract with neovascularization, left eye |
| H26.213 | Cataract with neovascularization, bilateral |
| H26.221 | Cataract secondary to ocular disorders (degenerative) (inflammatory), right eye |
| H26.222 | Cataract secondary to ocular disorders (degenerative) (inflammatory), left eye |
| H26.223 | Cataract secondary to ocular disorders (degenerative) (inflammatory), bilateral |
| H26.231 | Glaucomatous flecks (subcapsular), right eye |
| H26.232 | Glaucomatous flecks (subcapsular), left eye |
| H26.233 | Glaucomatous flecks (subcapsular), bilateral |
| H26.31 | Drug-induced cataract, right eye |
| H26.32 | Drug-induced cataract, left eye |
| H26.33 | Drug-induced cataract, bilateral |
| H26.8 | Other specified cataract |
| H26.9 | Unspecified cataract |
| H27.01 | Aphakia, right eye |
| H27.02 | Aphakia, left eye |
| H27.03 | Aphakia, bilateral |
| H27.111 | Subluxation of lens, right eye |
| H27.112 | Subluxation of lens, left eye |
| H27.113 | Subluxation of lens, bilateral |
| H27.121 | Anterior dislocation of lens, right eye |
| H27.122 | Anterior dislocation of lens, left eye |
| H27.123 | Anterior dislocation of lens, bilateral |
| H27.131 | Posterior dislocation of lens, right eye |
| H27.132 | Posterior dislocation of lens, left eye |
| H27.133 | Posterior dislocation of lens, bilateral |
| H28 | Cataract in diseases classified elsewhere |
| Q12.0 | Congenital cataract |
| Q12.1 | Congenital displaced lens |
| Q12.2 | Coloboma of lens |
| Q12.3 | Congenital aphakia |
| Q12.4 | Spherophakia |
| Q12.8 | Other congenital lens malformations |
ICD-9 Diagnosis Codes
| ICD-9 Codes | Description |
|---|---|
| 366.00 - 366.04 | Nonsenile cataract unspecified - nuclear nonsenile cataract |
| 366.09 | Other and combined forms of nonsenile cataract |
| 366.10 | Senile cataract unspecified |
| 366.13 - 366.19 | Anterior subcapsular polar senile cataract - other and combined forms of senile cataract |
| 366.20 - 366.23 | Traumatic cataract unspecified - partially resolved traumatic cataract |
| 366.30 - 366.34 | Cataracta complicata unspecified - cataract in degenerative ocular disorders |
| 366.41 - 366.46 | Diabetic cataract - cataract associated with radiation and other physical influences |
| 366.8 | Other cataract |
| 366.9 | Unspecified cataract |
| 379.31 - 379.34 | Aphakia - posterior dislocation of lens |
| 743.30 - 743.35 | Congenital cataract unspecified - congenital aphakia |
| 743.36 | Congenital anomalies of lens shape |
| 743.37 | Congenital ectopic lens |
| 743.39 | Other congenital cataract and lens anomalies |
| 996.53 | Mechanical complication of prosthetic ocular lens prosthesis |
1. The medical record should clearly indicate the condition being evaluated and the primary diagnosis should support the medical necessity of the testing.
2. If an ophthalmic biometry procedure is performed in preparation for cataract surgery, the medical record documentation maintained by the performing provider must clearly indicate the medical necessity of the service being billed. In addition, documentation that the service was performed must be included in the patient’s record in the office/progress notes and/or an operative report. This documentation should include the patient’s name and date of service, the indications for testing, an order for testing, the results of testing, and the IOL power calculation.
3. Documentation must be available to Medicare upon request.
There are three ophthalmic biometry methods, but two of the three methods are used for intraocular lens power calculation.
- A-Scan Ultrasound Ophthalmic Biometry
- Optical Coherence Ophthalmic Biometry
Report an A-Scan Ultrasound Ophthalmic Biometry with CPT code 76516.
CPT code 76516 is classified as a bilateral procedure where the bilateral adjustment does not apply. Because of this, this procedure should not be coded as a global service.
When testing both eyes, use the following coding guidelines:
To follow these coding guidelines, the technical component represents the performance of the procedure on both eyes. It is reported on one service line with a -TC modifier.
The professional component is a unilateral procedure representing the interpretation of the test results on one eye. The right eye is reported on a second service line with a -26 modifier and its location modifier -RT. The left eye is reported on a third service line with a -26 modifier and its location modifier -LT.
This Medicare carrier does not have specific utilization guidelines for ophthalmic biometry with IOL calculation. One (1) ophthalmic ultrasound (either A-scan or B-scan) may be allowed per eye per year. If these services are required more than once a year, a copy of the medical record that supports the medical necessity may be requested for review.