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Contact lens codes: Make the most of your contact lens services for your patients—and your practice

July 12, 2013

By Jason Miller, O.D., AOAExcel™ medical & records consultant

In the face of health care reform, contact lenses are vitally important to the optometric business model. Advanced contact lens materials, designs and solution systems have improved optometrists’ ability to provide a comfortable contact lens wearing experience—but being able to properly code and be reimbursed for your time, expertise and materials is critical to success.

You may be missing a key opportunity if you neglect to promote your treatment protocol with contact lens wearers. Developing a strong foundation will, in turn, create a strong business revenue center. Here are eight ways to make sure you do it right:

1. Unique codes for aphakic fits

Aphakic contact lens fits are often reimbursed through the patient’s medical carrier.

Keep in mind that this service is separate from any evaluation & management services or general ophthalmological services, which should be reported using the appropriate code (99000 or 92000 series) if that level of service was performed and met.

The codes for aphakic contact lens fits are either 92311 (for one eye) or 92312 (for both eyes). Current Procedural Terminology (CPT) defines these as:

  • 92311: “Prescription of optical and physical characteristics of and fitting of contact lens, with medical supervision of adaptation; corneal lens for aphakia, one eye.”
  • 92312: “Prescription of optical and physical characteristics of and fitting of contact lens, with medical supervision of adaptation; corneal lens for aphakia, both eyes.”

Make sure to bill the appropriate material code (V code) that most closely matches the material and design of the lenses:

  • V2513: Gas-permeable lens, extended wear, per lens.
  • V2530: Hybrid contact lens.
  • V2531: Gas-permeable scleral lens, per lens.
  • V2599: Contact lens, other type, per lens.

2. Unique codes for therapeutic lens fits

The CPT codes for therapeutic contact lenses changed Jan. 1, 2012. CPT code 92070 was retired and replaced with the following codes:

  • 92071: Fitting of contact lens for treatment of ocular surface disease.
  • 92072: Fitting of contact lens for management of keratoconus, initial fitting only.

Unfortunately, not every medical insurer carrier will pay for these codes. So contact the patient’s medical insurer in advance to determine what, if anything, they will pay for before proceeding.

It’s important the patient knows the total amount they will owe before you provide the services, rather than after.

3. Don’t neglect ocular surface disease

Ocular surface disease is a very familiar situation encountered by eye care professionals. Providing medical eye care, including bandage contact lenses (rigid or soft), to these patients can be a powerful addition to an optometric practice. Bandage soft contact lenses can help relieve pain and promote healing in patients with trauma to the cornea, and larger diameter scleral lenses are often prescribed for other ocular surface conditions.

Corneal abrasion is one of the most common uses for these lenses in primary care practices. In the presence of a corneal abrasion, bandage soft contact lenses shield the corneal surface from the constant mechanical irritation of the blinking eyelids. Once the lens is placed on the eye, patients feel considerable comfort almost immediately and, by controlling the pain, they can return to normal function.

For the billing and coding:

  • Bill the office visit at the appropriate level (92xxx or 99xxx), if performed and recorded.
  • Bill for the fitting of the contact lens for the treatment of the ocular surface disease (CPT 92071). Be sure to indicate the specific eye (right or left) because this code is unilateral in nature.
  • Bill a material fee as well. Choose either CPT 99070 (supplies and materials, except 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, per lens).

Note that many providers typically use a disposable contact lens for this purpose, and it is inappropriate to bill for a non-revenue lens (trial or diagnostic lens).

4. Take care with specialty services like keratoconus

Many patients require specialty contact lenses for either vision or comfort reasons. Specialty lenses are valued for their ability to mask corneal irregularities associated with various diseases, including keratoconus. If you’re working with a vision plan:

  • The benefit for “medically necessary” contact lenses is usually in addition to, and not a substitute for, eyeglasses. Check to see if you can obtain spectacles for your patient as well.
  • Complete a pre-authorization form to determine the patient’s eligibility ahead of time.

For a keratoconus contact lens fit submitted to the medical carrier:

  • Bill the office visit at the appropriate level (92xxx or 99xxx), if performed and recorded.
  • Bill the fitting of the contact lens for the treatment of keratoconus (CPT 92072—a bilateral code).
  • Bill a material fee with the most appropriate V code (most likely V2530, V2531 or V2599).

92072 describes the act of fitting keratoconus lenses for both eyes, establishing parameters and ordering the lenses. It does not include the follow-up visits, which should be charged separately using the most appropriate office visit code (99xxx or 92xxx).

It is a travesty that some carriers do not perceive this service (92072) as a covered medical service and will not reimburse for it. These patients often desire and need special medical attention, and too often the bill often falls back on the patient. Be sure to use an Advance Beneficiary Notice of Noncoverage (ABN) appropriately and within the guidelines as provided by the carrier.

Your contact lens business is vitally important to the success of your optometric practice. These steps will improve your in-office protocols and the ability to be reimbursed appropriately for your time and expertise.

Other helpful references can be found at www.aoacodingtoday.com.

The views expressed are those of the authors and do not necessarily reflect the views of the AOA.

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