Ophthalmology and Optometry Coding Alert

Question: My ophthalmologist routinely sees patients for services such as contact lens fittings. Can you explain the difference between the 92310-92313 series of procedure codes and the 92314-92317 series? What determines whether I should choose a code from one series over the other?

Virginia Subscriber

Answer: Your code choice depends on who performed the fitting. CPT^® codes 92310-92313 (Prescription of optical and physical characteristics of and fitting of contact lens, with medical supervision of adaptation ...) describe fitting of contact lenses by an ophthalmologist or other qualified physician.

Codes 92314-92317 (Prescription of optical and physical characteristics of contact lens, with medical supervision of adaptation and direction of fitting by independent technician ...) describe fittings done by an independent technician in the ophthalmologist’s office. Report 92310-92313 only if the ophthalmologist or another physician in your office — not an independent technician — is doing the contact lens fitting as well as supervising the adaptation.

Keep in mind: Medical plans vary in their coverage of contact lenses. Medicare will not reimburse for 92310 or 92314 (… corneal lens, both eyes, except for aphakia) if they correct only normal vision abnormalities such as farsightedness, or nearsightedness. You should be able to get reimbursement for contact lens services when they are required for functional vision such as after cataract surgery or for keratoconus, but the benefit is very restricted.

When the ophthalmologist prescribes the corneal contact lens and does the fitting for an aphakic patient, report 92311 (... corneal lens for aphakia, 1 eye) or 92312 (... corneal lens for aphakia, both eyes). For prescriptions and fittings of corneoscleral lenses use 92313 (… corneoscleral lens).

If the ophthalmologist or optometrist is prescribing the lenses but an independent contractor technician in your office does the actual fitting, report 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, 1 eye) or 92316 (... corneal lens for aphakia, both eyes) when it’s for a patient with aphakia, and 92317 (... corneoscleral lens) when fitting corneoscleral lenses.