Fitting a contact lens can play a critical role in a patients post-surgical recovery process and long-term visual well-being. While the fitting of the contact lens may be difficult, coding and billing for a post-surgical fit is rather easy and uncomplicatedif done properly.
To do so, youll need to know a few basic Current Procedural Terminology (CPT) codes for fitting and a few useful modifiers to allow you to further describe necessary clinical situations. Keep in mind that the medical record must describe the medical necessity for any codes used.
Post-Surgical Contact Lenses
The CPT manual has this to say about contact lens fitting: The prescription of contact lenses includes specification of optical and physical characteristics (such as power, size, curvature, flexibility and gas-permeability). It is not a part of the general ophthalmological services. The fitting of a contact lens includes instruction and training of the wearer and incidental revision of the lens during the training period.
To this end, the fitting codes used for post-surgical cases are 92310-12 and 92070. Here they are with their corresponding CPT definitions:
92310: Prescription of optical and physical characteristics of and fitting of contact lenses, with medical supervision of adaptation; corneal lens, both eyes, except for aphakia.
92311: Prescription of optical and physical characteristics of and fitting of contact lenses, with medical supervision of adaptation; corneal lens for aphakia, one eye.
92312: Prescription of optical and physical characteristics of and fitting of contact lenses, with medical supervision of adaptation; corneal lens for aphakia, both eyes.
92070: Fitting of contact lens for treatment of disease, including supply of the lens. Be aware that the Centers for Medicare & Medicaid Services (CMS) groups lens supply and lens for the treatment of disease together under CPT code 92070.
Once you have the right codes at hand, the process for coding post-surgical contact lens fittings is fairly simple.
If its an aphakic case, use codes 92311 or 92312, as appropriate. Once the fit has been completed and a contact lens Rx issued to the patient as required, then that code has been fulfilled and completed. Document any additional follow-up care, code this care with an appropriate 992XX code, and bill it to the medical carrier, not the refractive carrier.
If you are fitting for post-surgical cases other than aphakia, use codes 92310 or 92070; use the code determined by the surgical/post-surgical condition. Keep in mind that when using codes 92310-12, materials are billed separately with the appropriate V codes (such as V2500 for PMMA, spherical, per lens, or V2510 for gas permeable, spherical, per lens). But, when using 92070, the contact lens materials are already included in that code and included in the subsequent reimbursement.
If a case is particularly complicated, you can append the fitting code with CPT modifier -22. Modifier -22 (increased procedural services) underwent both a title and definition change in 2008. When the work required to provide a service is substantially greater than typically required, modifier -22 may be added to the usual procedure code. Documentation must support the additional work and the reason for it (such as increased intensity, time, technical difficulty of procedure, severity of patients condition, or physical and mental effort required). This modifier should not be appended to an evaluation and management service, but to the contact lens fitting procedure code.
Post-surgical contact lens fitting can be a complicated, yet fulfilling, endeavor for both the patient and you. Understand that youre providing a valuable service, so its only appropriate that you communicate this properly to medical carriers.
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Vol. No: 146:05Issue: