Article

The Business of Contact Lenses

Medically Necessary Insanity

The Business of Contact Lenses

Medically Necessary Insanity

BY CLARKE D. NEWMAN, OD, FAAO

We need to start over with codes for necessary prescribing. I want to tell all prescribers to tear out those pages from their CPT books. The codes that we have, 92310 to 92317, and to a lesser extent 92071 and 92072, do not reflect what goes on during the prescribing of medically necessary contact lenses.

Instead, the CPT codes from 92073 to 92080 just happen to be available. I know we have to go through an audit committee at the American Medical Association (AMA), and all stakeholders have to be included, but I wonder if AMA (and all the payors who use its codes) has the slightest clue that the current codes are terrible? The prescribing should be by condition and not lens type, and services should be clearly delineated.

My Proposal

Table 1 has my new codes, and here is my proposed preamble: Medically necessary contact lens prescribing services cover only the diagnostic prescribing of the lens geometric, optical, and material parameters. Ancillary tests needed to determine lens parameters should be billed separately. The eye exam should be billed using either general ophthalmological codes or evaluation/management (E/M) service codes.

TABLE 1 New Proposed Codes
92071 Medically necessary contact lens diagnostic prescribing visit, treatment of ocular surface disease.
92072 Medically necessary contact lens diagnostic prescribing visit, treatment of a thinning disorder of the cornea.
92073 Medically necessary contact lens diagnostic prescribing visit, treatment of aphakia.
92074 Medically necessary contact lens diagnostic prescribing visit, treatment of significantly progressive myopia to control progression.
92075 Medically necessary contact lens diagnostic prescribing visit, treatment of significantly high refractive errors and/or significant anisometropia.
92076 Medically necessary contact lens diagnostic prescribing visit, treatment of nystagmus.
92077 Medically necessary contact lens diagnostic prescribing visit, treatment of corneal transplant or other anomalies of corneal size and shape not due to a thinning disorder of the cornea.
92078 Medically necessary contact lens diagnostic prescribing visit, treatment of visual disability caused by congenital or acquired disfigurement of the eye, not cosmetic.
92079 Medically necessary contact lens diagnostic prescribing visit, treatment of other condition.
92080 Medically necessary contact lens dispensing visit.

Medically necessary contact lens prescribing services should be used only for the beginning of each discrete prescribing interval. Use general ophthalmological or E/M service codes for subsequent follow-up and “refit” visits.

No two prescribing codes should be used on the same eye on the same day. All codes are unilateral and not subject to the bilateral exemption. Lens materials should be billed separately using the appropriate Healthcare Common Procedure Coding System (HCPCS) code. Use of –RT and –LT modifiers is required.

Stop the Insanity

OK, AMA, adopt my version without changes! You can have back the 92310-92317 codes. CLS


Dr. Newman has been in private practice in Dallas since 1986 specializing in vision rehabilitation through contact lenses as well as corneal disease management, optometric medicine, and refractive surgery. He is a Diplomate in the AAO and a consultant to B+L, AMO, and Alden Optical. Contact him at cdnewman@earthlink.net.