billing & coding
Contact Lens Fits Part
Two
Continuing the review
of CPT codes 92070 and 92310.
CARLA
MACK, O.D.
Last
month's column highlighted the differences between two CPT codes for contact lens
fitting. Here, we'll expand on that topic. The procedure code of choice for disease
treatment is 92070. Use this when the purpose of the lens is:
• not for visual function.
• to promote healing, decrease
pain, aid in therapeutic drug delivery and/or maintain ocular surface hydration.
• part of the rehabilitative process
or treatment plan.
• for treatment of corneal pain
and corneal epithelial disruption in neurotrophic keratitis, filamentary keratitis,
Thygeson's superficial punctate keratopathy, bullous keratopathy and corneal dystrophies.
The CPT code 92070 is unilateral and
requires the appropriate –RT or –LT modifier. Personally, I have designated
this code almost exclusively for bandage lens cases.
When treating acute corneal pain and
epithelial erosion or punctate keratopathy from vascularized limbal keratitis (VLK)
or superior limbic keratoconjunctivitis (SLK), 92070 better describes the reason.
However, when fitting the same patient following the resolution of VLK or SLK, code
92310 is better.
|
CODE |
PURPOSE |
LENS |
92070
Includes supply of contact lens |
Fitting for treatment of disease; corneal
erosion, keratopathy, chemical toxicity, corneal abrasion, keratitis, corneal
dystrophy |
Bandage lens; promote healing, decrease pain,
therapeutic drug delivery, maintain ocular surface hydration.
|
92310
Does not include supply of contact lens |
Fitting including prescription of optical and physical characteristics,
with medical supervision of adaptation; except for aphakia. |
Soft sphere, toric, and multifocal GP sphere, toric and multifocal, including keratoconus. |
Keratoconus
There is a great deal of confusion over the proper
use of 92310 and 92070 for keratoconus. Reimbursement, especially for 92070, may
seem low and in some cases, doesn't cover the cost of the lenses.
In the early stages, spectacles may
provide adequate vision. Spherical or toric soft contact lenses are also options.
In these cases, most agree that CPT 92310 describes the process well.
If a patient requires a small or large
diameter GP lens or specialty, soft lens, use 92310. The lens is not treating or
rehabilitating the corneal ectasia. However, it is necessary for good vision. And
it often takes considerable effort over a number of visits to find the best prescription
and fit. A great deal of time is spent on the fitting relationship and achieving
the BCVA, as well as maintaining good corneal physiology. For these reasons, I believe
92310 better represents the fitting process. Contact lens supply is not incorporated
into the fitting process and thus requires an additional lens V code designation.
Gray area
Medicare does not cover contact lens fitting for
keratoconus. A prior written authorization from you to the patient's medical insurance
is often necessary to obtain coverage. Determine an appropriate fee that best represents
your expertise and time. Unfortunately, some insurance companies' reimbursement
levels for 92310, even with a medical diagnosis such as keratoconus, will leave
you mystified. You can also use intermediate comprehensive eye examination code,
920XX and evaluation and management code, 992XX, in addition to your 92310 fitting
code.
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: July 2006