As many of you know, I have managed the Billing and Coding Module for the GP Lens Institute (GPLI) and written this column for Contact Lens Spectrum for about 13 years now. On almost a daily basis, I get billing and coding questions by email, mainly about contact lens prescribing. Some of these questions come through the GPLI website, but most of them come from Contact Lens Spectrum readers like yourself. There is a lot of repetition in these questions, but when we get a new question that I think is really good, regardless of the source, we add it to the FAQ (frequently asked question) Section in the GPLI Billing and Coding Module.

It has been some time since I went through the FAQs in this column. So, I think it is time to address a few of those really good questions—especially since most of the questions come from this readership.

“V” Codes Explained

One reader asked whether the American Medical Association (AMA) Healthcare Common Procedure Coding System (HCPCS) “V” codes are only for medically necessary lens prescribing or whether they can be used for cosmetic prescribing as well. These codes are used to describe materials such as contact lenses and glasses. The “V” Section of the HCPCS includes the Level II Common Procedural Terminology (CPT) codes for glasses, contact lenses, and hearing aids. The contact lens codes range from V2500 to V2531. V2599 is used to describe lenses not described in the V2500 to V2531 codes, and the V2627 describes the scleral cover shell contemplated in the Centers for Medicare & Medicaid Services (CMS) National Carrier Determination (NCD) 80.5.

For a billed code to be payable by a medical plan or a medically necessary benefit under a vision care plan, a medical diagnosis is required. However, there is no prohibition on using the codes for cosmetic prescribing. In fact, I encourage it. Contact lenses are more of a commodity—even the custom, proprietary GP and hydrogel lenses. So, using the “V” codes makes sense for tracking purchases of materials.

There are a few quirks in this schema. CPT Guidelines state that you should choose the code for which the plain language of the code most closely matches the service, procedure, or material being provided. The V2531 code is, “Contact lens, scleral, gas permeable, per lens.”

We could easily construe that the hybrid lenses belong here, because they are gas permeable and the haptic orients on the sclera. However, the medical insurance industry has settled on the V2599 for this type of lens pretty much uniformly.

Also, you sign contracts not to bill a payor more for the same code than you bill another carrier. So, set fees that are rational for each code and stick to them. If you have a lens that is significantly more costly—such as a lens made from an impression of the eye—then you are best using the V2599 and supplying a letter of necessity.

92071 for Sclerals for Dry Eye

Another reader asked about using the 92071 (Fitting of contact lens for treatment of ocular surface disease) code for scleral lenses for dry eye. For some reason, large hospital systems have landed on this code for this type prescribing.

Again, CPT states that when a code exists for a service, procedure, or material for which the plain text of the code is more appropriate, then all other codes are not correct. Because there are codes 92313 and 92317, which describe the prescribing of a scleral lens, then that code is correct, and the 92071 is not correct when billing a V2531 as the material code. CLS