Ophthalmology and Optometry Coding Alert

Question: Which code should we use for monthly replacement toric contacts? We have been using V2599 (Contact lens, other type), but I was wondering if there is a better code.

Indiana Subscriber Answer: For toric monthly disposables - prescribed for astigmatic patients - report HCPCS code V2521 (Contact lens, hydrophilic, toric or prism ballast, per lens). Since monthly lenses are more than likely soft (hydrophilic), V2521 would be appropriate.

Don't expect payment from Medicare, however. The HCPCS manual points out, "Hydrophilic contact lenses are covered by Medicare only for aphakic patients." Medicare's national coverage determination (NCD) for hydrophilic lenses is clear: They won't cover lenses "when used in the treatment of nondiseased eyes with spherical ametrophia, refractive astigmatism and/or corneal astigmatism."

If the patient received toric gas-permeable lenses, report V2511 (Contact lens, gas permeable, toric, prism ballast, per lens), but this would probably not be a monthly contact.