MY FEBRUARY COLUMN focused on various organizations that exist in the cornea and contact lens space, joining these organizations, and attending meetings. Recently, one of the best specialty lens conferences, the Global Specialty Lens Symposium (GSLS), was held in Las Vegas. Here are a few takeaways that I have from GSLS.

During one insightful conversation, Clark Chang, OD, MSA, MSc, who received the GP Lens Institute’s Tommy Pham GPLI-NKCF Keratoconus Practitioner of the Year Award, had two coding questions.

First, how does a referring prescriber code and bill for the pre- and postoperative care of the cross-linking patient? First, the ICD-10-CM code for this procedure had better be “Keratoconus, unstable, H18.62x,” with the “x” being either “1” for the right eye, “2” for the left eye, or “3” for both eyes. Without this diagnosis a referral for corneal cross-linking, in most cases, is not indicated. I say “in most cases” because there are some U.S. Food and Drug Administration off-label uses for cross-linking that would require a different ICD-10-CM code.

The current CPT code for the surgical procedure of corneal cross-linking is the CPT Level III, temporary code, 0402T. Normally, a surgical 60000 code contemplates the pre- and postoperative care in the relative value units of the surgical code. Also, there is always a global period of postoperative care assigned. These periods are either “0 days,” “10 days,” or “90 days.”

However, temporary Level III codes contain neither pre- nor postoperative care. Further, there is no global period associated with these codes. So, the answer to Dr. Chang’s first question is that the practitioner would bill the rational General Ophthalmological or the appropriate Evaluation & Management code for the service that the practitoner provides. Bill for any ancillary testing rational to the diagnosis for the preoperative visit or postoperative visit as well.

One caveat, though. This temporary code is set to sunset in January 2025. So, there will likely be an AMA Edit Committee created to formalize a 60000 code for cross-linking. After that happens, the pre- and postoperative care will be part of the surgical code, and there will likely be a global period associated with this code that would exclude co-management until the global period has passed. The trend now is to assign global periods of “0.”

His second question: When should an optometrist use the 0402T code and the HCPCS Level III code “J2787 – Riboflavin 5’- phosphate, ophthalmic solution, up to 3ml”? The answer is yes, if the optometrist is the treating surgeon. In some states, performing cross-linking is within the optometrists’ scope of practice. So, they might be performing the procedure, and they would use these codes.

In other GSLS highlights, I was very impressed by the lecture by Mark Bullimore, MCOptom, PhD, and Ian Flitcroft, MA D.Phil (oxon), MB, BS, FRCOphth, on Phase 3 of the Childhood Atropine for Myopia Progression (CHAMP) trial on low-dose atropine. The results looked promising. The lecture by Lyndon Jones, PhD, DSc, on novel advances in contact lens technologies showed that contact lenses will be used for more than just vision in the very near future. Drug delivery, disease telemetry, and virtual displays are all in the near future of contact lens prescribing.

One of the most provocative lectures at GSLS was the very last one of the conference. Patrick Caroline and Randy Kojima’s lecture on a completely new way of thinking about prescribing corneal GP lenses created great discomfort for the old, hardened lens prescribers like myself—and for good reason. I must say that this information about larger, vaulting corneal lenses was very interesting. CLS