Wiki Keratoconus patients

[dalanicks@aol.com]

Can someone advise which is the more appropriate code to use when billing keratoconus patients fit Scleral lenses

92072 (bilateral) or 92313 (with RT and LT modifiers)

Thank you

 

[Cheezum51]

Use 92072. It's more appropriate because you're fitting an abnormal cornea. Realize that most insurance plans don't pay for fitting of these lenses or if they do, they don't pay enough to cover the time or materials required. As it says in the CPT book, use the 92012 code for each follow up visit.

Some Vision Care Plans, especially VSP, will pay a substantial amount towards the fitting of lenses for keratoconus patients.

Tom Cheezum, OD, CPC, COPC

 

[dalanicks@aol.com]

ok that's what we thought, thank you, do you think they should do a few no charge visits, almost like a post op, they have been doing that, I told them they should be using a 92012 as well

 

[Cheezum51]

In terms of progress check visits, it kind of depends on how the patient is charged. Most offices will not do these types of fittings when billed through a major medical plan because they limit your fees for materials, which don't usually cover the cost of the lenses at all, and they tell the patient that your 92072 is maximum allowable fee for the fitting.

If they are billing insurance and not charging for each follow up with a 92012, they're throwing money away!!!

Most offices charge a flat fee that includes lenses, fitting and follow up for anywhere from 30-90 days. The average seems to be about $1500 but that isn't a recommendation for what you should charge.

 

[dalanicks@aol.com]

Thank you so much Dr. Cheezum, I agree with you with the 92012 as f/u with the medical insurance. I had asked another resource the same question and two people had two different answers, one agreed using the 92072 for the scleral lenses which I agree as well, but someone turned around and said that they used 92310 with the V2531. She said they submit the V code first then the 92310 with modifier XC which I never heard of, have you heard of that?

 

[Cheezum51]

Never heard of an XC modifier for that CPT code, or for any code.
The V2531 is submitted, I would imagine, to see if the insurer will cover the lens expense. I can't find the 2019 fee for that but, from past experience, the allowable fees didn't come close to the cost of the lenses and, once again, the provider can get locked into having to accept the low fee by filing with the insurance.

Tom Cheezum, OD, CPC, COPC