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Optometry Coding & Billing Alert

CPT BASICS ~ Why You Should Dump the Status Quo for Contact Lens Reporting


- Published on Fri, Jan 12, 2007

Find out which service is often underpaid by carriers
 
CPT 2006 altered the contact lens section -- here are the crucial changes that coders must know.

CPT 2006 deleted 92330 (Prescription, fitting and supply of ocular prosthesis [artificial eye], with medical supervision of adaptation) and 92335 (Prescription of ocular prosthesis [artificial eye] and direction of fitting and supply by independent technician, with medical supervision of adaptation).

New instructions direct you to report an E/M code (99201-99215) or general service codes 92002-92004 (Ophthalmological services: medical examination and evaluation with initiation of diagnostic and treatment program; ... new patient) and 92012-92014 (Ophthalmological services: medical examination and evaluation, with initiation or continuation of diagnostic and treatment program; ... established patient) in place of the deleted codes.

CPT 2006 also deleted all of the -Supply of Materials- codes (92390-92396), covering the supply of spectacles, contact lenses, low-vision aids and ocular prostheses. Revised instructions in the -Contact Lens Services- section read, -The supply of contact lenses may be reported as part of the service of fitting. It may also be reported separately by using the appropriate supply codes.- Keep this list handy:

- 92310 -- Prescription of optical and physical characteristics of and fitting of contact lens, with medical supervision of adaptation; corneal lens, both eyes, except for aphakia

- 92311 -- - corneal lens for aphakia, one eye

- 92312 -- - corneal lens for aphakia, both eyes

- 92313 -- - corneoscleral lens

- 92314 -- Prescription of optical and physical characteristics of contact lens,with medical supervision of adaptation and direction of fitting by independent technician; corneal lens, both eyes except for aphakia (for prescription and fitting of one eye, add modifier 52)

- 92315 -- - corneal lens for aphakia, one eye

- 92316 -- - corneal lens for aphakia, both eyes

- 92317 -- - corneoscleral lens

- 92325 -- Modification of contact lens (separate procedure), with medical supervision of adaptation

- 92326 -- Replacement of contact lens.

Add modifier 52 (Reduced services) for prescription and fitting of one eye (for example, 92310-52). You should report follow-up of successfully fitted extended-wear lenses as part of a general service (92012, Ophthalmological services: medical examination and evaluation, with initiation or continuation of diagnostic and treatment program; intermediate, established patient).

Watch for Underpayment for Lens Services
 
For example:
When fitting a keratoconus patient with a new type of contact lens, report 92310 for the contact lens services and an appropriate code from the V2500-V2599 series (Contact lens ...) for the supplies.

Caution: Carriers often underpay 92070 (Fitting of contact lens for treatment of disease, including supply of lens) for what the optometrist does because of the wide price variability for a contact lens.

Many offices provide lenses ranging in price from less than $45 to more than $180 each. Yet there are only limited CPT codes to cover contacts. One code cannot cover such a wide range of products, so try to bill services and [...]

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