Ophthalmology and Optometry Coding Alert

Question: We have a post-corneal-graft patient and we need to do topographical mapping in order to fit a contact lens properly. The code we use for this procedure is 92499 (unlisted ophthalmological service or procedure). However, not all insurance companies will pay separately for this procedure. The question is: should we charge the patient for corneal mapping, or can we bundle it with either a 99215 or a 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)?

Colorado Subscriber


Answer: There are several options depending on the type of insurance company with which you are dealing.

(1) You could appeal to the insurance company to pay for the service by providing a copy of the test, and a note stating why it is medically necessary to perform the service.

(2) If you do not have a contract with the insurance company that obligates you to write off services that they will not approve, you can bill the patient.

(3) If you do have a contract that prohibits you from billing the patient for services the insurance company denies or bundles, you can use the contact lens fitting code you referenced: 92310. Make sure that you use modifier
-52 if you are only fitting one eye.

(4) CPT code 99215 has specific requirements. Unless the levels of complexity are documented in your medical record, it is not recommended to upcode the office visit to capture reimbursement for the corneal topography.