Gail Posted Tue 28th of August, 2012 14:20:38 PM
Which code would be correct for the fitting of contacts if for medical condition "high anismetropia", 92310 or 92072 ?
SuperCoder Answered Tue 28th of August, 2012 15:44:01 PM
The first step is to stay away from CPT code 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). This is the right code for prescribing lenses to correct refractive error - which Medicare and most other carriers won't reimburse for.
The code you report depends on the medical condition the lenses will treat. For keratoconic patients, report 92070 (Fitting of contact lens for treatment of disease, including supply of lens). Since the code includes the supply of the lens, you should not have to bill for that separately.
For aphakic patients, report 92311 (... corneal lens for aphakia, one eye), 92312 (... corneal lens for aphakia, both eyes) or 92313 (... corneoscleral lens). If you're writing the prescription for the lenses but an independent contractor technician in your office does the actual fitting, report 92315 (Prescription of optical and physical characteristics of contact lens, with medical supervision of adaptation and direction of fitting by independent technician; corneal lens for aphakia, one eye), 92316 (... corneal lens for aphakia, both eyes) or 92317 (... corneoscleral lens).
Anisometropia is the condition in which the two eyes have unequal refractive power, I recommend to use this code only.
Gail Posted Wed 05th of September, 2012 19:45:54 PM
Thank you for all the helpful info. The last sentence "Anisometropia etc..., I recommend to use this code only. Which code are you referring to for the fitting?
SuperCoder Answered Fri 07th of September, 2012 22:09:34 PM
I apologize for not clearing the doubt earlier.
Infact, I was referring to 92310.But since this code is not reimbursable by medicare and many insurances, choose 92072 to distinguish reporting fitting of contact lens for treatment of ocular surface disease and fitting of contact lens for management of keratoconus.
Its always beneficial to contact the local insurance regarding code submission and the appropriate documentation submission for the code to clarify.