Article

BUSINESS: CODING STRATEGY

THE CONTACT LENS FITTING

HERE’S WHY YOU NEED TO CONTROL THE FIT AND THE PRESCRIPTION

CONTACT LENSES are are a ubiquitous part of optometric practice. Over the past decade, we have witnessed continuous erosion of revenues related to materials. As competitive sales channels abound, the average practitioner has had to take advantage of more sophisticated sales strategies, such as annual supply, direct ship and, of course UPP, though it failed of to prop up prices to the consumer. With the exception of UPP, the success of these strategies rely on the communication skills of your team.

CONTACT LENS SERVICES

The obvious oversight here is that we are trying to compete with market variables that we can’t control, instead of concentrating on what we can: the contact lens prescription. The prescription is not simply the type of lens and the refraction, as some treat it, but it is the result of a much more complicated process, a contact lens fitting as defined by the CPT. In fact, the CPT is fairly inclusive of what is included in a contact lens fitting :

  • The prescription of contact lens includes specification of optical and physical characteristics (such as power, size, curvature, flexibility, gas-permeability). It is not a part of the general ophthalmological services.
  • The fitting of contact lens includes instruction and training of the wearer and incidental revision of the lens during the training period. Supply of materials may be reported as part of the fitting service, or may be reported separately using the appropriate supply codes.
  • Follow-up of successfully fitted extended-wear lenses is reported as part of a general ophthalmological service (92012).

A deeper dive into the definition of the most common contact lens fitting code, 92310, shows we have significant responsibility when it comes to fitting a lens. Also according to 2017 CPT:

  • (92310) - “prescription of optical and physical characteristics of and fitting of a contact lens, with medical supervision of adaptation; corneal lens, both eyes, except for aphakia.” If fitting only one eye, use modifier -52, not the -RT or -LT modifier; this change was implemented in 2011.

A 92310 encompasses fitting services up to the point at which you would issue a contact lens prescription. Some important additional points to understand:

  • This code does not include contact lens follow-up care after the lenses have been dispensed.
  • This code is charged every visit a new lens is placed on a patient’s eye or the fit is altered. Incidental revisions without altering the fit, such as power changes, are not billed as a new fitting.

Thousands of dollars in revenue is given away by practitioners by including these services free. If you are refitting a patient and you are not performing an “incidental revision of the contact lens,” then you should be billing the patient again for your expertise in correcting the clinical issue at hand.

CODE APPROPRIATELY

The battle in price for the materials will continue, specifically in a market led by retail powers more sophisticated and with greater profit elasticity than the average O.D. However, the retailer has nothing to sell if there isn’t a prescription issued. Those who control the fit, control the prescription and, thereby, have better control over profitability related to their intellectual property.

An in-depth understanding of what you are providing, as defined by the CPT, may aid you in understanding the true value of the contact lens fit and its role in your practice profitability. OM