Ophthalmology and Optometry Coding Alert

Question: I'm having trouble getting non-Medicare carriers to reimburse the practice for therapeutic contact lenses. How can I get them to pay?

Wyoming Subscriber

Answer: The first step is to stay away from 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).

This is the right code for prescribing lenses to correct refractive error which Medicare and most other payers won't reimburse -- but not the correct code for fitting of therapeutic lenses.

The code you report depends on the medical condition the lenses will treat. For keratoconic patients, report 92070 (Fitting of contact lens for treatment of disease, including supply of lens). Since the code includes the supply of the lens, you should not bill for that separately.

For aphakic patients, report 92311 (... corneal lens for aphakia, one eye), 92312 (... corneal lens for aphakia, both eyes), or 92313 (... corneoscleral lens). If your ophthalmologist is writing the prescription for 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, one eye), 92316 (... corneal lens for aphakia, both eyes), or 92317 (... corneoscleral lens).