Coding and Billing

Scleral Contact Lenses: Coding Dos & Don’ts

By Mark Wright, OD, FCOVD,
and Carole Burns, OD, FCOVD

March 7, 2018

Scleral contact lenses play an important role in your treatment of some patients, and can add to your profitability–and can be challenging to code for. Here are keys to keep in mind when coding for treatment that includes scleral contacts lenses.

Scleral lenses, originally made in the 1800’s in glass, and now made in highly oxygen permeable polymers, are making a strong come back. Scleral lenses are being used to treat astigmatism, severe dry eye syndrome, microphthalmia, keratoconus, corneal ectasia, Stevens–Johnson syndrome, Sjögren’s syndrome, aniridia, neurotrophic keratitis, complications post-LASIK, higher-order aberrations, complications post-corneal transplant, pellucid degeneration, surgical complications, distorted corneal implants, chemical injuries and burn injuries. As you can see, sclerals are a valuable, workhorse lens.

Most vision insurance plans reimburse for scleral lenses. Both the lens fittings and the lens materials are usually reimbursed more than other types of contact lenses making them a good source of revenue for the practice. Medicare also reimburses for scleral contact lenses. For other medical carriers it can be difficult, but you can still obtain reimbursement.

PROCEDURE CODES
The contact lens section of the CPT codebook has the following language that applies to all contact fits: “The fitting of contact lens includes instruction and training of the wearer and incidental revision of the lens during the training period.”

There are six CPT procedure codes and descriptions that you should know. Here they are.
92310 – “Prescription of optical and physical characteristics of and fitting of contact lens, with medical supervision of adaptation; contact lens, both eyes, except for aphakia.”

92311 – “Prescription of optical and physical characteristics of and fitting of contact lens, with medical supervision of adaptation; contact lens for a aphakia, one eye.”

92312 – “Prescription of optical and physical characteristics of and fitting of contact lens, with medical supervision of adaptation; corneal lens for a aphakia, both eyes.”

92313 – “Prescription of optical and physical characteristics of and fitting of contact lens, with medical supervision of adaptation; corneoscleral lens.” (Note: Even though the CPT description of this code does not specify unilateral or bilateral, it should be considered a unilateral fit.)

92071 – “Fitting of contact lens for treatment of ocular surface disease.”

92072 – “Fitting of contact lens for management of keratoconus, initial fitting only.”

It is important patients know what the out-of-pocket bill will be before you deliver services or materials. Be aware that not every third party will pay for these codes, so be sure to find out what the documentation and payment requirements are for each patient’s carrier.

We should note here that after the patient has been successfully fit, if complications arise, bill for office visits using the appropriate established patient 92000 or 99000 code because you are managing an ocular complication, and you are no longer engaged in contact lens fitting.

You can use the Medicare Physician Fee Schedule Look-up Tool to find out what Medicare reimburses for scleral lens procedures in your area of the country. Here is the information from that tool for the 2018 National Payment Amount for a Non-Facility.

MATERIAL CODES
The two Healthcare Common Procedure Coding System Level II codes describing scleral lenses are:
V2530 – Contact Lens, Scleral, gas Impermeable, Per Lens
V2531 – Contact Lens, Scleral, Gas Permeable, Per Lens

Depending on the lens technology you are using, there are two other material codes that may be applicable. They are:
V2599 – Contact Lens, Other Type (N/A)
V2627 – Scleral Cover Shell

It is interesting to note that many carriers are now requesting invoices in addition to standard documentation. To be prepared for this, scan the contact lens invoice and attach it to the patient’s digital medical record.

Unlike Medicare and medical insurances where you bill for the procedure and the lenses separately, most vision insurances usually incorporate the scleral lens fitting, the materials, the dispensing, and the follow-ups, within a fixed time frame into one fee.

Take this week to examine the procedure and material codes you use in your practice for scleral lenses.

References
[1] “Sjögren’s Syndrome Foundation Releases Clinical Practice Guidelines for Ocular Management in Sjögren’s Patients”. Sjögren’s Syndrome Foundation. Sjögren’s Syndrome Foundation. Retrieved 25 February 2016.

[1] Caceres, Vanessa (June 2009). “Taking a second look at scleral lenses”. ASCRS EyeWorld. Retrieved 18 May 2014.

[1] https://en.wikipedia.org/wiki/Scleral_lens

 

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