Global Keratoconus Congress in Las Vegas was a remarkable gathering
of nearly 500 attendees including corneal surgeons, optometric
clinicians, technicians, researchers, educators and exhibitors.
Cathy Warren, RN, Executive Director of the National Keratoconus
Foundation, moderated a discussion on keratoconus patient management
issues including coding, billing and insurance reimbursement. I
presented this information in February's
Readers' Forum, Insurance Coding for Keratoconus Lens Fitting.
were a number of valid and insightful comments and questions from
the GKC attendees on coding for the keratoconus examination, contact
lens fitting and follow-up care. I'd like to share some of the
candid thoughts from our discussions.
general agreement that CPT 92310 better represents the contact lens
fitting for keratoconus compared to CPT 92070.
appears to be no interpretation standard regarding contact lens
fitting code 92310. By CPT definition, it includes medical
supervision of adaptation and incidental revision of the lens during
the training period (CPT 2007). These phrases aren't inherently
clear. How many visits and how many lens design changes does this
practitioners use the 92310 as a global fee encompassing multiple
office visits until they determine a final prescription. Others code
for the appropriate level evaluation and management code (9921X) or
an intermediate eye examination code (92012) at each patient visit.
insurance tips were offered from GKC attendees.
your responsibilities in regard to your contract agreement with
Different plans under one insurance company may have different
bill the patient for non-covered services. Many vision and medical
insurance plans will deny coverage for the contact lens materials.
a brochure that helps explain the nuances of vision and medical
insurance as well as the practice fees.
consistent coding logic and ensure consistency among all members of
* Use the
Insurance Reimbursement Request Form on the National Keratoconus
Foundation Web site (www.nkcf.org
) under the resource link.
appropriate to code for other medically necessary procedures in
addition to the office visit code or to the contact lens fitting
code. Procedures that may be warranted for your keratoconus patient
include corneal topography (92025), external ocular photography
(92285), corneal pachymetry (76514) and modification of the contact
know there are three diagnosis codes specific to keratoconus? Use
the code that best represents a patient's condition. If the patient
is a keratoconus suspect, code the patient signs and symptoms (Table