Wiki Fitting of Contact Lens

[catlady283]

I work in an Outpatient Clinic in a Military Treatment Facility. One of my Opth providers asked the following question:

Patient presents for annual eye exam and is fitted with contact lens (CL) and she codes 92310. The patient is instructed to return in 2-3 weeks for a CL check. Patient returns 2-3 week later for the contact lens check. Provider then codes 92012. Provider and I want to know is the contact lens follow up encompassed in the initial fitting. If not, can she continue to use the 92012 or whatever code the documentation supports? Any help and guidance would be appreciated.

 

[annawade13]

Hi Tonja,

Most routine vision payers consider a certain number of follow-up visits to be included in the initial fit fee. They will usually state in their contract how many return visits are included. In my experience it's usually been 2-3 visits. I've never had a provider use 92012 for a routine contact lens check, nor have I seen a vision payer that would pay it. Is your provider being reimbursed for these 92012s?

 

[rhotonscott]

Follow-up for CL check is usually coded with a 99212 unless there is a new diagnostic/treatment requiring reexamination: ie ocular surface disorder due to the
CL wear. Medical necessity and payer determine this.

 

[AlaskanCoder]

The explanation of code 92310 in the Coding Companion for Opthalmology 2013 edition includes: "The fitting includes instruciton and training of the wearer and incidental revision of the lens during the training period." This would imply that routine follow-up is included. I have never had a provider bill me for the follow-up within a month of the initial fitting and would not return to any provider who did. Additionally, a follow-up cataract check would probably not meet the criteria of an intermediate eye exam.
Karen Hill, CPC, CPMA