the business of contact lenses

BY CARLA J. MACK, OD, FAAO

Coding Tips for Keratoconus from GKC

The first Global Keratoconus Congress in Las Vegas was a remarkable gathering of nearly 500 attendees including corneal surgeons, optometric clinicians, technicians, researchers, educators and and exhibitors. Cathy Warren, RN, Executive Director of the National Keratoconus Foundation, moderated a discussion on keratoconus patient management issues including coding, billing and insurance reimbursement. I presented this information in February’s Readers’ Forum, "Insurance Coding for Keratoconus Lens Fitting."

There were a number of valid and insightful comments and questions from the GKC attendees on coding for the keratoconus examination, contact lens fitting and follow-up care. I’d like to share some of the candid thoughts from our discussions.

There was general agreement that CPT 92310 better represents the contact lens fitting for keratoconus compared to CPT 92070.

There appears to be no interpretation standard regarding contact lens fitting code 92310. By CPT definition, it includes "medical supervision of adaptation" and "incidental revision of the lens during the training period" (CPT 2007). These phrases aren’t inherently clear. How many visits and how many lens design changes does this imply?

Some practitioners use the 92310 as a global fee encompassing multiple office visits until they determine a final prescription. Others code for the appropriate level evaluation and management code (9921X) or an intermediate eye examination code (92012) at each patient visit.

Insurance Tips

These insurance tips were offered from GKC attendees.

• Know your responsibilities in regard to your contract agreement with insurance carriers.
• Different plans under one insurance company may have different coverage.
• Balance bill the patient for non-covered services. Many vision and medical insurance plans will deny coverage for the contact lens materials.
• Design a brochure that helps explain the nuances of vision and medical insurance as well as the practice fees.
• Have consistent coding logic and ensure consistency among all members of the practice.
• Use the Insurance Reimbursement Request Form on the National Keratoconus Foundation Web site (www.nkcf.org) under the resource link.

Additional Procedure Codes

It’s appropriate to code for other medically necessary procedures in addition to the office visit code or to the contact lens fitting code. Procedures that may be warranted for your keratoconus patient include corneal topography (92025), external ocular photography (92285), corneal pachymetry (76514) and modification of the contact lens (92325).

Diagnosis Coding

Did you know there are three diagnosis codes specific to keratoconus? Use the code that best represents a patient’s condition. If the patient is a keratoconus suspect, code the patient signs and symptoms (Table 1). CLS