Ophthalmology and Optometry Coding Alert

Question: Can I bill for contacts? We have a Medicare patient with keratoconus who needs contacts. New York Subscriber Answer: You may be tempted to assign 92310 (Prescription of optical and physical characteristics of and fitting of contact lens, with medical supervision of adaptation; corneal lens, both eyes, except for aphakia). But this is not the appropriate code for keratoconus patients (371.60-371.62). With this diagnosis, you should code 92070 (Fitting of contact lens for treatment of disease, including supply of lens). 92310 is for treating a refractive error, and Medicare does not cover the treatment of refractive problems.

The kind of contact lens used to treat keratoconus is a bandage contact lens. Using 92070 in patients with keratoconus shows that the lens is for treatment of a medical condition, not a refractive condition. Advice for You Be the Coder and Reader Questions provided by Raequell Duran, president, Practice Solutions, Santa Barbara, Calif.