Bucks for Bandage CLs
Clear the common payment hurdles.
Douglas K. DeVries, O.D.
Getting fully compensated for bandage contact lens (CL) care, as with other eyecare services in the managed care world, is easier said than done.
Here’s how to overcome the common reimbursement obstacles:
1. Use an FDA-approved lens.
You must use a hydrophilic CL approved by the FDA for use as a therapeutic CL to get reimbursed. These CLs: Acuvue Oasys (Vistakon), Air Optix Night & Day (CIBA Vision), PureVision (Bausch + Lomb) and Soft 55 EW (Unilens).
2. Purchase plano CLs.
Buy plano CLs specifically for use as therapeutic bandages. This precludes the possibility of losing reimbursement that could occur during an audit by billing for a non-purchased CL. So, don’t use a low power CL that is part of an already-purchased trial lens set.
3. Use the new code.
Effective Jan. 1, 2012, 92071 is the code for the fitting of a hydrophilic CL used as a moist corneal bandage. Medicare defines this code as bilateral (bill once whether one or both eyes are treated). A caveat: The 92071 code should not be used when fitting a keratoconus patient. This is a specific medical condition and has a specific fitting procedure covered under the 92072 code. The 2012 national Medicare Physician Fee Schedule allowable for 92071 is $37 and does not include the CL.
Next, use the supply code V2599. (This is a supply code not otherwise specified in a procedure code and is not bundled in the physician service.)
92071 is the code for a bandage contact lens.
4. Select the right ICD-9 code.
Therapeutic bandage CLs used in the promotion of healing or for pain management are covered by Medicare and most insurance companies. Medicare’s National Coverage Determination states,
“Some hydrophilic contact lenses are used as moist corneal bandages for the treatment of acute or chronic corneal pathology, such as bullous keratopathy, dry eyes, corneal ulcers and erosions, keratitis, corneal edema, descemetocele, corneal ectasias, Mooren’s ulcer, anterior corneal dystrophy, neurotropic keratoconjunctivitis and for other therapeutic reasons.” Employ ICD-9 codes to justify the fitting of and payment for therapeutic CLs.
Examples of such ICD-9 codes:
•371.23 Bullous keratopathy
•375.15 Tear film insufficiency, unspecified
•370.73 Keratoconjunctivitis sicca
•371.20 through 371.24 Corneal edema
•371.52 Anterior corneal dystrophy
•371.71 Corneal ectasia
•918.1 Corneal abrasion
•371.42 Recurrent corneal erosions
5. Provide Advanced Beneficiary Notification.
Medicare and private insurance companies may reject claims for the frequent replacement of bandage CLs due to the billing frequency of the 92071 and the V2599 codes. Therefore, have the patient sign an Advanced Beneficiary Notification of non-coverage prior to dispensing the bandage CLs.
When treating various acute as well as chronic corneal conditions, a therapeutic bandage CL could very well be a part of your treatment plan. Proper billing of the therapeutic bandage CL will ensure you’re compensated for this service. OM
DR. DEVRIES HAS A DEGREE IN FINANCIAL MANAGEMENT FROM THE UNIVERSITY OF NEVADA SCHOOL OF BUSINESS AND IS CO-FOUNDER OF EYE CARE ASSOCIATES OF NEVADA, A MEDICAL/SURGICAL CO-MANAGEMENT REFERRAL PRACTICE. E-MAIL HIM AT DRDEVRIES@NVEYELASER.COM, OR SEND COMMENTS TO OPTOMETRICMANAGEMENT@GMAIL.COM.
Optometric Management, Volume: 48 , Issue: January 2013, page(s): 54