Wiki Billing contacts for keratoconus

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bobsgirl

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The patient has $150 for vision hardware and up to $10,000 for DME. How do I bill to get the contacts covered as medically necessary under DME? At first Regence didn't pay at all and now they're paying them as vision hardware. There has to be a way. Is it a modifier? Maybe a specific code?

Thanks!
 
It should be the diagnosis code that supports the contacts as medically necessary (not to correct a refractive error) and all of my payers pay as a medical supply not a vision service. I'd appeal the payer's decision to cover as a vision service.

Karen Hill, CPC, CPMA
 
so are you billing cl's for treatment of keratoconus under DME benefits? If so, what is the procedure code you are billing?

Thanks
Sheila
 
Sheila, that's one of my problems. The last code I used was V2502 and that paid at regular vision benefits. Is there a specific code for contacts used for keratoconus?
 
As far as I know, there are only the V codes for gas perms or soft cls. Some payers seem to like 99070 for keratoconus lenses, but I don't like to use it since there are more descriptive codes out there. The truth is, payers are always going to have a hard time with these benefits; we just need to keep at them and be a nuisance until they finally pay just to get rid of us. ;)
 
bobsgirl said:
Sheila, that's one of my problems. The last code I used was V2502 and that paid at regular vision benefits. Is there a specific code for contacts used for keratoconus?
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Sorry for the late response. Regency will use the DME benefits if you provide all the documentation required. This documentation will show Regency that the patient has the best corrected acuity with the RGP lens is. there guidelines are on the provider web portal (what all is required). This documentation usually is a topography, refraction, 1 year supply of lens cost and v-code, fit examination, and office exam. hope this helps.
 
If this is the initial CL fitting....then you can bill 92072 with modifier 50. This should NOT be subject to the DME limit as this is considered an exam per the AMA/CPT....

I am currently a Practice Admin for an Ophthalmology group which is I also double as the coder. If you should have any additional questions, please feel free to contact me.

Kandy Morris CPC, COBGC, CEMC
kandy@coasttocoastmedbilling.com
bicostalcpc@hushmail.com(HIPAA Compliant)
 
mzkandy83 said:
If this is the initial CL fitting....then you can bill 92072 with modifier 50. This should NOT be subject to the DME limit as this is considered an exam per the AMA/CPT....

Yes, but the contacts (supplies) are separate from the exam code now (versus the prior code 92070 which included the supply). So could be subject to the DME limit, correct?

Karen Hill, CPC, CPMA
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