CLINICAL: contact lenses
Billing for OSD Bandages
How to submit for reimbursement
JASON R. MILLER, O.D., M.B.A., F.A.A.O.
For some ocular surface disease (OSD) patients who do not feel relief from symptoms with standard treatments, such as warm compresses, lid scrubs and artificial tears, bandage contact lenses and biological corneal bandages can be used to quell ocular dryness, foreign-body sensation and pain, while safeguarding the cornea from damage.
These two procedures sound alike, but are very different in their treatment abilities and billing procedures. There are many different clinical presentations that we encounter, such as corneal abrasions, in which a bandage contact lens is necessary, compared with an exposure keratopathy case, in which a biological bandage can provide improved clinical outcomes. Knowing how to differentiate the billing for these procedures is crucial for timely reimbursement.
Here, I discuss how to bill for the fitting of these bandages.
Billing for bandage contact lenses
Follow these steps to receive reimbursement for this service:
▸ Use the appropriate level (92xxx or 99xxx) to bill for the office visit, depending on what was done during the encounter.
▸ Employ CPT 92071, which is the code for fitting a contact lens for the treatment of OSD. Be sure to indicate the specific eye (RT or LT) because this code is unilateral in nature.
▸ Use either CPT 99070 (supplies and materials, sans spectacles, provided by the physician over and above those usually included with the office visit or other services rendered) or the appropriate “V” code (most likely V2523: contact lens, hydrophilic, extended wear). Other “V codes” include:
▸ V2513: GP lens, extended wear, per lens
▸ V2530: Hybrid contact lens
▸ V2531: GP scleral lens, per lens
▸ V2599: Contact lens, other type, per lens. (This code is used for intralimbal lenses, etc.)
The supply code is billed separately; however, Medicare identifies 99070 as always bundled with the associated code, so there is no separate payment for the bandage contact lens. The national CMS payment amount for this procedure is $38.69, but check your local coverage determination (LCD) to determine the exact payment.
Billing for biological bandages
These bandages are comprised of thermoplastic rings and an amniotic membrane. Therefore, they are not bandage contact lenses and should be not be billed as such. The procedure code that describes these bandages is 65778, or “placement of amniotic membrane on the ocular surface for wound-healing; self-retaining.”
No additional codes are needed when billing for this procedure. (HCPCS code V2790, “Amniotic membrane for surgical reconstruction per procedure,” is no longer eligible for Medicare payment in any setting. Reimbursement for the supply is included with payment for the procedure and Medicare.)
The national payment amount by CMS for this procedure is $1,388.85. Again, check your LCD to determine exact payment.
Diagnose it, and treat it.
Take the initiative to actively diagnose and treat chronic OSD patients, which is important for their healing, and properly bill these procedures, which benefits your practice. OM
*Special thanks to Walt Whitley, O.D., M.B.A. for his assistance with this article.
Optometric Management, Volume: 49 , Issue: April 2014, page(s): 36