Ophthalmology and Optometry Coding Alert

Situation: A patient doesn't have her own natural lens (aphakia, 379.31 or 743.35). The ophthalmologist fits a contact lens for refractive error correction. You can't use 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) in this case -- it says so right in the code description. Which code should you report?

Solution: The codes for aphakic patients differ based on whether the doctor fit one or both eyes, says Becky Zellmer, CPC, MBS, CBCS, provider educator for Prevea Clinic in Green Bay, Wis. Choose from the following codes:

• Prescription for one eye: 92311 (Prescription of optical and physical characteristics of and fitting of contact lens, with medical supervision of adaptation; corneal lens for aphakia, one eye)

• Prescription for both eyes: 92312 (... corneal lens for aphakia, both eyes)

• Prescription for corneoscleral lens: 92313 (... corneoscleral lens).

Medicare will pay for contact lens fitting and supply for patients with aphakia. If an ophthalmologist writes the prescription for an aphakia patient, but a technician who is an independent contractor in your office does the actual fitting, code one of the following:

• Prescription for one eye: 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)

• Prescription for both eyes: 92316 (... corneal lens for aphakia, both eyes)

• Prescription for corneoscleral lens: 92317 (... corneoscleral lens).

Beware: Most Medicare carriers have established guidelines for how often they will replace a contact lens for an aphakic patient. One claim every one or two years per aphakic eye is what many carriers expect to receive.

For supplies: Bill your DMERC for the lenses themselves using the HCPCS V25XX codes (for example, V2510, Contact lens, gas permeable, spherical, per lens), adding the RT (Right side) and LT (Left side) modifiers for each eye and modifier KX (Specific required documentation on file) to indicate medical necessity. Include the date of the original surgery and the diagnosis code.