The Business of Contact Lenses

Billing the Prescribing Codes, Part 2

BY CLARKE D. NEWMAN, OD, FAAO

Let’s continue our discussion of coding and billing for medically necessary lenses by looking at the two newest Current Procedural Terminology (CPT) prescribing codes: 92071 and 92072.

Using 92071

Use the 92071 code when you prescribe a bandage lens. The text and subtext language for the 92071 code reads: “Fitting of Contact Lens for Treatment of Ocular Surface Disease *Do not Report 92071 in Conjunction with 92072 *Report Supply of Lens Separately With 99070 or Appropriate Supply Code.” The first subtext instruction is from the Correct Coding Initiative (CCI) and forbids billing the bandage code and the keratoconus code at the same visit. The second subtext instruction tells you to bill the lens separately.

The Centers for Medicare & Medicaid Services (CMS) has a long-standing national carrier determination (NCD) policy for this code. The NCD 80.1 states:

“Some hydrophilic contact lenses are used as moist corneal bandages for the treatment of acute or chronic corneal pathology, such as bullous keratopathy, dry eyes, corneal ulcers and erosion, keratitis, corneal edema, descemetocele, corneal ectasis, Mooren’s ulcer, anterior corneal dystrophy, neurotrophic keratoconjunctivitis, and for other therapeutic reasons.

Payment may be made under §1861(s)(2) of the Social Security Act for a hydrophilic contact lens approved by the Food and Drug Administration (FDA) and used as a supply incident to a physician’s service. Payment for the lens is included in the payment for the physician’s service to which the lens is incident. Medicare Administration Contractors [MACs] are authorized to accept an FDA letter of approval or other FDA published material as evidence of FDA approval. (See §80.4 of the NCD Manual for coverage of a hydrophilic contact lens as a prosthetic device.)”

The lens does not have to be FDA approved for a bandage indication. If you use a diagnostic lens that you did not pay for, then you should not bill for the materials; you can bill if you purchase lenses for this express use. However, the 99070 code is almost always a non-covered service. You have to use the “appropriate supply code,” which means a CPT Level II Healthcare Common Procedure Coding System (HCPCS) code, or “V” code, which is unilateral.

When you use a HCPCS code, bill your Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) MAC rather than your Medicare Part B MAC for the materials. The track record of reimbursement for these billings is dismal.

Using 92072

The text and subtext language for the 92072 code reads as follows: “92072—Fitting of Contact Lens for Management of Keratoconus, Initial Fitting *For Subsequent Fittings, Report Using Evaluation and Management Services or General Ophthalmological Services *Do not Report 92072 in Conjunction With 92071 *Report Supply of Lens Separately With 99070 or Appropriate Supply Code.”

This code is bilateral and subject to the reduced services modifier. The same CCI instruction is there. The second subtext instruction states that follow-up and subsequent fitting visits are separate and to use either general ophthalmological service codes or E/M services. When instructed to use these codes, the new complaint rule of the general ophthalmological codes doesn’t apply. The instruction regarding materials is the same as with 92071. CLS

Dr. Newman has been in private practice in Dallas, Texas since 1986 specializing in vision rehabilitation through contact lenses as well as corneal disease management, optometric medicine, and refractive surgery. He is a Diplomate in the AAO and a consultant to B+L, AMO, and Alden Optical. Contact him at cdnewman@earthlink.net.