Article Date: 6/1/2006

billing & coding
Contact Lens Fits and Prescriptions
Part one helps you choose the most accurate codes.
CARLA MACK, O.D.

There is much confusion and differing opinion over the use of two CPT codes for fitting contact lenses. I've received a number of requests on this matter. The codes in question are 92070 and 92310.

At first glance, there is an apparent overlap because both codes are used to identify a contact lens fitting procedure. However, 92310 also takes into account the determination of the prescription of the contact lens, which includes lens power, base curve(s), diameter, material and other identifying optical and physical characteristics of the lens. CPT 92070 does not require an additional supply code (such as V2510, V2520, etc.) to designate the contact lens type provided. When using 92310, you may report the patient supply as part of the fitting or as an additional appropriate supply code. The following example from our office may help better differentiate the two.

Figure 1: Corneal abrasion at first visit.

Bandage Contact lens

An established patient reported to the office with corneal trauma. Two days prior, the patient had an accident in which soap squirted on to the front surface of the right eye. He reported considerable pain, decreased vision and photophobia, none of which were improving. We diagnosed the patient with a large corneal abrasion (see figure 1).

Treatment consisted of a topical antibiotic and a topical cycloplegic, as well as fitting and supply of a low-power bandage contact lens. Currently, two silicone hydrogel lenses are FDA-approved for therapeutic use, Night & Day (lotrafilcon A, CIBA Vision) and Purevision (balafilcon A, Bausch & Lomb).

We coded the initial visit with the appropriate level evaluation and management visit code, 99213 in this case, and code 92070 for the fitting and supply of the bandage lens, as well as code 99285 for anterior segment photography. The diagnosis codes for this example were corneal abrasion (918.1) and secondary iritis (364.04). The patient had several follow-up visits where we assessed corneal health with biomicroscopy and high mol-ecular weight fluourescein through the lens, but did not remove the bandage lens (see figure 2).

Treatment or prescription

The purpose of the contact lens fitting for this patient was clearly management of the disease process or corneal abrasion. The bandage contact lens helped decrease corneal pain, promote corneal healing and provide mechanical protection from the eyelids.

Figure 2: Corneal staining with bandage lens after five days of treatment.

The contact lens was not intended to improve this patient's vision, nor did we give him a prescription for the silicone hydrogel lens after the fitting, follow-up and resolution of the corneal abrasion. For those reasons, CPT code 92070 more accurately describes the fitting process for this patient. The cost of the medical device or contact lens in this case is bundled within the fitting fee, so the patient is not charged with a separate supply code. I use CPT code 92070 almost exclusively for bandage lens situations such as this.

In the next column, we will further clarify the use of these contact lens fitting codes, as well as provide tips for coding keratoconus and other corneal surface disease processes such as vascularized limbal keratitis.

DR. MACK IS DIRECTOR OF CLINICS AT THE OHIO STATE UNIVERSITY COLLEGE OF OPTOMETRY. SEND E-MAIL TO CMACK@OPTOMETRY.OSU.EDU.

 



Optometric Management, Issue: June 2006