Contact Lens Fits Part Two

Optometric Management, Jul 2006 by Mack, Carla

Continuing the review of CPT codes 92070 and 92310.

Last month's column highlighted the differences between two CPT codes for contact lens fitting. Here, we'll expand on that topic. The procedure code of choice for disease treatment is 92070. Use this when the purpose of the lens is:

* not for visual function.

* to promote healing, decrease pain, aid in therapeutic drug delivery and/or maintain ocular surface hydration.

* part of the rehabilitative process or treatment plan.

* for treatment of corneal pain and corneal epithelial disruption in neurotrophic keratitis, filamentary keratitis, Thygeson's superficial punctate keratopathy, bullous keratopathy and corneal dystrophies.

The CPT code 92070 is unilateral and requires the appropriate -RT or -LT modifier. Personally, I have designated this code almost exclusively for bandage lens cases.

When treating acute corneal pain and epithelial erosion or punctate keratopathy from vascularized limbal keratitis (VLK) or superior limbic keratoconjunctivitis (SLK), 92070 better describes the reason. However, when fitting the same patient following the resolution of VLK or SLK, code 92310 is better.

Keratoconus

There is a great deal of confusion over the proper use of 92310 and 92070 for keratoconus. Reimbursement, especially for 92070, may seem low and in some cases, doesn't cover the cost of the lenses.

In the early stages, spectacles may provide adequate vision. Spherical or toric soft contact lenses are also options. In these cases, most agree that CPT 92310 describes the process well.

If a patient requires a small or large diameter GP lens or specialty, soft lens, use 92310. The lens is not treating or rehabilitating the corneal ectasia. However, it is necessary for good vision. And it often takes considerable effort over a number of visits to find the best prescription and fit. A great deal of time is spent on the fitting relationship and achieving the BCVA, as well as maintaining good corneal physiology. For these reasons, I believe 92310 better represents the fitting process. Contact lens supply is not incorporated into the fitting process and thus requires an additional lens V code designation.

Gray area

Medicare does not cover contact lens fitting for keratoconus. A prior written authorization from you to the patient's medical insurance is often necessary to obtain coverage. Determine an appropriate fee that best represents your expertise and time. Unfortunately, some insurance companies' reimbursement levels for 92310, even with a medical diagnosis such as keratoconus, will leave you mystified. You can also use intermediate comprehensive eye examination code, 920XX and evaluation and management code, 992XX, in addition to your 92310 fitting code.

CARLA MACK, O. D.

DR. MACK IS DIRECTOR OF CLINICS AT THE OHIO STATE UNIVERSITY COLLEGE OF OPTOMETRY. SEND E-MAIL TO CMACK@OPTOMETRY.OSU.EDU.