Optometry Coding & Billing Alert

Question: I-m confused about when I should use 92070 versus 92310. Which one should I use when the optometrist administers a keratoconus contact lens?

Virginia Subscriber

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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) when your optometrist fits a keratoconus patient for a contact lens. But this is not the appropriate code for keratoconus patients (371.60-371.62).

Right way: With a keratoconus diagnosis, you should report 92070 (Fitting of contact lens for treatment of disease, including supply of lens). Code 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 for keratoconus patients shows that the lens is for treatment of a medical condition, not a refractive condition.

Remember: Don't code separately for lenses for keratoconic patients.

Because 92070 specifies that supplies are included, do not code separately for them -- so you shouldn't separately report the lens to a durable medical equipment regional carrier (DMERC).