Ophthalmology and Optometry Coding Alert

Find out which service is often underpaid by carriers CPT has altered the contact lens section -- here are the crucial changes you 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 ophthalmological service codes 92002 (Ophthalmological services: medical examination and evaluation with initiation of diagnostic and treatment program; intermediate, new patient) and 92014 (... comprehensive, established patient, one or more visits) 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)

For therapeutic or surgical use of contact lens, see 68340 (Repair of symblepharon; division of symblepharon, with or without insertion of conformer or contact lens), 92070 (Fitting of contact lens for treatment of disease, including supply of lens)

You should report follow-up of successfully fitted extended wear lenses as part of a general ophthalmological 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 for what the physician does because of the wide price variability for a contact lens.

Many offices provide lenses ranging in price from [...]