Ophthalmology and Optometry Coding Alert

Question: What is the correct way to code for aphakia lenses? We have been receiving denials with 92315 and 92316.

New York Subscriber

Answer: Aphakia lenses are placed when the eye has no lens, either congenitally or from an injury that requires removal of the natural lens. This differs from fixing a regular refractive error. Continue to use 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) and 92316 ( corneal lens for aphakia, both eyes) for the fitting. Use diagnosis code V43.1 (Organ or tissue replaced by other means; lens) or 379.31 (Aphakia).

With aphakic contact lenses, there is also a supply issue. Aphakic patients are legally blind without their contact lenses. If they wear aphakic contact lenses, Medicare is required to replace one per aphakic eye a year as medically necessary. Medicare carriers will only pay once per eye per lifetime for a patient with an intraocular lens.