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Thread: Aphakic Contact Lens Code

  1. #1
    Join Date
    Apr 2007
    Mooresville NC

    Default Aphakic Contact Lens Code

    AAPC: Back to School
    Hi Everyone,

    Is there anyone out there who knows how to code for an aphkic contact lens? The manufacturer is ABB Concise. The design is an Edge Lift Spherical. We coded it as V2521 and were denied for medical necessity. Has anyone had any luck or should I say expertise getting this paid? Help!!
    Vanda Crawford, CPC

  2. #2
    Join Date
    Apr 2007
    Martinez California Chapter

    Default Aphakic contact lens billing

    Hi Vanda,
    It looks like you want to bill for the supply of the lens, and am assuming this is a Medicare patient. I haven't done this for years because aphakic patients are far and few between these days now that IOLs are so safe. But this is what we used to do: If you are just replacing a lens that was previously fit and it has gotten old, torn, or lost, use 92326 and attach modifier -RT or -LT. Use the office's standard mark-up for speciality contact lenses, (% times cost), for the amount. Attach the invoice from Concise to justify medical necessity, and use 379.31 as the diagnosis.
    If the lens was prescribed and fit by your provider, use 92315 with the -RT or LT modifier. This is a global-type service, so figure in the retail price of the lens, and the number of visits that is expected to finalize the fit (chair time). If you have to send it back to adjust power or parameters, 92325 can be billed separately, but the office visit(s) would be included. I have never used a Vxxxx for this purpose, because it is going to the Medical insurance. Vision insurances relate better to the Vxxxx. Depending on your carrier, the lens alone may have to be billed to the DME carrier. I know that the Aphakic Spectacles are now considered DME, but I haven't billed an aphakic CL since that change was made. If the patient is aphakic in both eyes, Medicare used to allow 2 pair or a total of 4 lenses per year. Another alternative is to speak with your Concise Account Representative. They are usually very knowledgeable and supportive. Don't be surprised if it gets declined again. I have worked for a multi-specialty group whose billing entity refused to even submit the claim because "medical insurances do not pay for contacts lenses." If it is declined, call the carrier to see what they are thinking. Hopefully they will just need a letter of medical justification from the provider. Don't give up, aphakic lenses are covered for the life of the patient. What you do to get this claim adjudicated correctly now, will save you time when the lens has to be replaced in about 6 months.
    Debra, COT, OCS, and currently training to be a CPC.

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