Take CPT Assistant to Boost Contact Lens Revenue

Getting insurance claims paid for prescriptive medical devices like contact lenses can be a tricky affair. Insurance carriers are not quick to reimburse for these, however by staying away from a few common errors, your contact lens claims stand a better chance of reaping rewards. Here's a quick rundown on ways to avoid pitfalls that you may face when filing a contact lens claim.

When an ophthalmologist, rather than a technician provides contact lens prescription and fitting, you should select codes like 92310. According to CPT guidelines, you should cover optical and physical characteristic specifications like power, size, curvature, flexibility, and gas-permeability, in the contact lens prescription service. According to the CPT manual, you should not consider a part of the general ophthalmological services.

On the other hand, contact lens fitting includes instructing and training the wearer. According to the CPT manual, it also includes the incidental lens revision during the training period.

And if a tech provides the contact lens services, you should look at codes like 92314.

You should be alert to whether you should bill contact lens procedures as bilateral or unilateral. According to CPT, code 92310 specifies "both eyes," so if you only do one eye, report 92310 with modifier 52 (Reduced services).

According to CPT guidelines, you may include contact lens supply as part of the fitting service, or you may report supply individually. To report a separate supply code, see V2500-V2599 series (Contact lens ...), which describes the materials you use for the case.

In order to report the follow-up of successfully fitted extended-wear lenses, you should bill it as a general service.

It's important that the ophthalmologist requires to document the right measurements for correct contact lens fitting, and document their findings for base curve, diameter, and power of the lens.

To know more about which CPT code is applicable for which service, just sign up for a one-stop medical coding guide. When you sign up for one, you can land the right CPT code with the help of ‘code look up' and CPT Assistant tools.