Ophthalmology and Optometry Coding Alert

Question: How do you code keratoconus? We have been using 92310 for fitting and 93010 for contact lens disease. Reimbursement from most payers is $136.00 for both the contacts and fitting.

Virginia Subscriber


Answer: You are correct using 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) for fitting and prescribing corneal contact lens for both eyes. But according to CPT, you should report supply of the contact lenses with 92391 (supply of contact lenses, except prosthesis for aphakia).

If your diagnosis code is correct for keratoconus (371.60), justifying the medical necessity for the contact lenses should not be a problem. Check with your Medicare carrier on any local medical review policies (LMRPs) for these services and also find out whether the keratoconus diagnosis is a validating diagnosis for the fitting and supply services youre billing. Although CPT has an explanatory note stating that the service of supplying materials (i.e., the contact lens) is not part of the fitting service, most Medicare carriers will not pay both the supply and the fitting. Other payers should have a fee schedule and coverage policy for both these codes.