Ophthalmology and Optometry Coding Alert

Question: I'm a little confused about coding for optical supplies. One of our patients got bifocals, and decided she wanted progressive lenses to get rid of the line between the two lenses. The optical shop, however, coded them as trifocal lenses (V2300) along with V2781 for the progressive lens. I don't think this is right, but the optical shop says they've always coded this way. What's the correct coding?


Oregon Subscriber

Answer: You should not submit a trifocal code (V2300-V2399) if you're actually providing bifocals. Instead, submit a bifocal code (V2200-V2299) on the first line of your claim. On the second line, report V2781 (Progressive lens, per lens) for the difference between the cost of the standard bifocal and the progressive lens. The patient is responsible for that difference, and should sign an advance beneficiary notice.

Example: The patient chooses a progressive lens with a cost of $100 per lens ($200 for the pair of lenses). Your retail charge for a standard bifocal lens is $45 ($90 for the pair). Code 2 units of V2200 (Sphere, bifocal, plano to plus or minus 4.00d, per lens) on the first line, with your standard total charge of $90. Code 2 units of V2781 on the second line with a total charge of $110 ($200 - $90). Your coding would look like this:

Line 1: V2200-RT-LT x 2

Line 2: V2781-EY-GA-RT-LT x 2

Append modifier EY (No physician or other licensed healthcare provider order for this item or service) to V2781 to show that the progressive lenses are the patient's preference, not a medically necessary addition. Append modifier GA (Waiver of liability statement on file) to show that the patient has signed an ABN and is aware that she is responsible for the additional charge for the progressive lenses.

Advice for You Be the Coder and Reader Questions provided by Maggie M. Mac, CMM, CPC, CMSCS, consulting manager for Pershing, Yoakley & Associates, Clearwater, Fla; and Raequell Duran, president of Practice Solutions, Santa Barbara, Calif.