Important Considerations for Bandage Lens Coding
BY CLARKE D. NEWMAN, OD, FAAO
In the kitchen "junk drawer" of coding and billing, there's a lot of stuff that you never need until you need it. I thought we'd look through that drawer this month to see if there is some treasure in there.
Most, but not all, of the third-party payers follow Medicare's lead when it comes to billing and coding. Therefore, it is very important, and not just for contact lens coding and billing, to know what Medicare is doing.
Medicare promulgates its rules and then communicates them through the "Publication 100" documents. In the Publication 100-03, you can find all of the National Carrier Determinations or NCDs.
The NCDs are interpretations that clarify the rules that Medicare has issued. You can find them on the web at www.cms.hhs.gov/manuals/downloads/ncd103c1_Part1.pdf. The eyecare NCDs are all contained in "Part 1" of the Pub 100-03 from pages 86 to 97.
Hydrophilic Bandage Lenses
In our junk drawer, I found NCDs 80.1, 80.4, and 80.5, which all address contact lens issues. This month, we'll look just at NCD 80.1, which covers hydrophilic lenses used as bandages. This relates to when to bill the CPT code 92070. The important text of this policy is as follows:
"Some hydrophilic contact lenses are used as moist corneal bandages for the treatment of acute or chronic corneal pathology, such as bulbous keratopathy, dry eyes, corneal ulcers and erosion, keratitis, corneal edema, descemetocele, corneal ectasis, Mooren's ulcer, anterior corneal dystrophy, neurotrophic keratoconjunctivitis, and for other therapeutic reasons.
Payment may be made under §1861(s)(2) of the Act for a hydrophilic contact lens approved by the Food and Drug Administration (FDA) and used as a supply incident to a physician's service. Payment for the lens is included in the payment for the physician's service to which the lens is incident."
There are some gems in this policy. First, you can bill Medicare, and almost all third-party carriers, for using a bandage lens on a dry eye. Also, you could make a case for billing Medicare for the hydrophilic carrier in a piggyback lens system if the patient has a "corneal ectasis," such as keratoconus. How can Medicare argue with it? It is right there in the plain language of its policy.
Also, you do not have to use a lens that has an FDA indication as a "therapeutic bandage lens." The only requirement is that the lens carries an FDA approval. This requirement basically covers all hydrophilic lenses on the market in the United States today. However, a few lenses are specifically approved for therapeutic use: CSI FW (CIBA Vision), Night & Day (CIBA), Acuvue Oasys (Vistakon), Permalens Therapeutic (CooperVision), Purevision (Bausch & Lomb), and Soft-55 EW (Unilens Corp.).
Other things to keep in mind are that you should never bill a CPT 9231x when using a lens as a bandage. Second, never bill for the lens because it is included in the code. The language for CPT 92070 is: "Fitting of contact lens for the treatment of disease, including supply of lens." Third, the office visit needed to remove the bandage lens is not included in the 92070 code. Fourth, the 92070 is not part of your original office visit, but is in addition to it. Finally, the text says "lens," not "lenses." So, if you put a bandage on each eye, bill it twice with your right eye and left eye modifiers. CLS
Dr. Newman has been in private practice in Dallas, Texas since 1986 specializing in vision rehabilitation through contact lenses as well as corneal disease management, optometric medicine and refractive surgery. He is also a consultant or advisor to B&L.